Desafios e mudanças no processo de trabalho das equipes de saúde da família no cenário pandêmico: relato de experiência / Challenges and changes in the work process of family health teams in the pandemic scenario: experience report

O presente estudo tem por objetivo realizar um relato de experiência demonstrando a percepção de discentes do curso de odontologia na sua participação na prática da atenção primária à saúde (APS), vivenciadas em um cenário pandêmico e com base no combate a enfrentamentos e desafios impostos no processo de trabalho das equipes de saúde da família. Este estudo trata - se de relato de experiência, de caráter descritivo e retrospectivo, associado à uma pesquisa bibliográfica para que trousse o embasamento teórico necessário para a descrição do relato de experiência vivenciado. No decorrer da pandemia, a Equipe de saúde da família exerceu importante papel e atuou na linha de prevenção e controle desta, sendo uma das maiores ferramentas de apoio. Na odontologia, a atuação da equipe de saúde bucal devido a fatores de risco inerentes à esta modalidade de ocupação, ficou limitada em seu exercício. O conhecimento de muitos dos profissionais da rede pública foi colocado em questão, assim como sua vivência, limitações e o medo de contrair a doença. Os profissionais da equipe de saúde, mostraram que o trabalho interprofissional e um bom relacionamento aumentou o incentivo e a responsabilidade de equipe.

This study aims to carry out an experience report demonstrating the perception of students of the dentistry course in their participation in the practice of primary health care (PHC), experienced in a pandemic scenario and based on the fight against confrontations and challenges imposed on the work process of family health teams. This study is an experience report, descriptive and retrospective, associated with bibliographical research to bring the necessary theoretical basis for the description of the lived experience report. During the pandemic, the Family Health Team played an important role and acted in the line of prevention and control of this, being one of the greatest support tools. In dentistry, the performance of the oral health team, due to risk factors inherent to this type of occupation, was limited in its exercise. The knowledge of many public health professionals was questioned, as well as their experience, limitations and fear of contracting the disease. Health team professionals showed that interprofessional work and a good relationship increased team incentive and responsibility.

Workplace dignity amongst clinical nurses.

BACKGROUND: The workplace environment plays a pivotal role in employees' lives as they spend many hours there. Recently, greater attention has been placed on workplace conditions as a key social determinant of health. One way through which workplace conditions may affect health is workplace dignity. This study aimed to describe clinical nurses' workplace dignity. METHODS: The study design was descriptive and cross-sectional. Clinical nurses within a tertiary institution were randomly sampled. Data collection included the Workplace Dignity scale which is an 18 item-seven-point Likert scale consisting of dignity and indignity questions (α.98, and 0.95, respectively). Data collection commenced with a pilot followed by a final data collection phase. Ethical considerations were included via informed consent, anonymity, and confidentiality. Data analysis included means, standard deviations, and Pearson correlations. RESULTS: The pilot test yielded a reliability coefficient - α 0.93. Two hundred and thirty-six clinical nurses participated in the study resulting in a response rate of 87.4%. The average mean age of participants was 37.966 ± 0.635 (min 25- max 60) years. Most participants were female (92.8%) with a Bachelor of Science in Nursing Degree (77.5%). The overall mean experience as a registered nurse was 16.038 ± 0.589 years. Nationality responses were divided into Saudi (41.5%) and non-Saudi (58.5%). The construct of general dignity had the highest mean score of 5.52 (SD 1.46), with question 14: "I have dignity at work" having the highest overall mean score of 5.63 (SD 1.4). There was a positive correlation and statistical significance with a 'p < 0.000 i.e. as a nurses' experience as a registered nurse increased, workplace dignity scores increased. CONCLUSION: The findings of this study indicated that inherent value and general dignity were the highest-scored constructs while indignity and respectful interaction scored the lowest. This study allows for reflection on the importance of workplace dignity, as an impactful and important organizational phenomenon that affects either positively or negatively on employee well-being and performance, hence workplace dignity must be prioritized within work environmental infrastructures.

Mental workload, musculoskeletal disorders, and associated factors among international transport truck drivers.

Introduction: Many health changes are related to how individuals respond to work events that are influenced by organizational, physical, and human factors. Objectives: We aim to evaluate the mental workload, the manifestation of musculoskeletal disorders, the associated factors, and their relationships among international transport truck drivers. Methods: This is a descriptive, cross-sectional diagnostic study of 70 truck drivers who entered the intermodal terminal of the city of Uruguaiana, state of Rio Grande do Sul, Brazil, in January 2021. Participants completed the NASA Task Load Index questionnaire and the Nordic Musculoskeletal Symptom Questionnaire, along with questions about work characteristics and health care. Results: The results showed that most truck drivers have a high mental workload (90.0%) and have experienced musculoskeletal symptoms in the past 12 months (72.9%). In addition, this occupational group has characteristics that are predictive of health problems, as most work over 10 hours a day (61.5%). The results also show a correlation between mental workload, hours worked, and lower back injuries (p < 0.05). There is also an association between hours worked and the occurrence of musculoskeletal disorders in the neck, shoulders, and lower back in the past 12 months and in the shoulders and lower back in the past 7 days, especially for those who work over 12 hours a day. Conclusions: The population studied had a high mental workload and a high prevalence of musculoskeletal disorders as well as occupational characteristics predictive of harm to both physical and mental health.

Introdução: Muitas alterações de saúde estão associadas à forma como os indivíduos reagem aos eventos do trabalho, estando vinculadas a fatores organizacionais, físicos e humanos. Objetivos: Avaliar a carga mental de trabalho, a manifestação de distúrbios musculoesqueléticos, os fatores associados e suas relações em caminhoneiros de transportes internacionais. Métodos: Trata-se de um estudo descritivo diagnóstico de corte transversal realizado no Porto Seco Rodoviário do Município de Uruguaiana, estado do Rio Grande do Sul, durante o mês de janeiro de 2021, no qual foram avaliados 70 caminhoneiros. Os participantes responderam ao Questionário NASA Task Load Index e ao Questionário Nórdico de Sintomas Osteomusculares, além de questões acerca das características do trabalho e cuidados com a saúde. Resultados: Os resultados demonstraram que a maioria dos caminhoneiros apresentou elevada carga mental de trabalho (90%) e apresentou sintomatologias musculoesqueléticas nos últimos 12 meses (72,9%). Ademais, a categoria profissional apresenta características preditoras de prejuízos à saúde, uma vez que a maioria trabalha mais de 10 horas por dia (61,5%). Ainda, os resultados indicam correlação entre a carga mental de trabalho e as horas trabalhadas e as injúrias lombares (p < 0,05). Também houve correlação entre as horas trabalhadas e a manifestação de distúrbios musculoesqueléticos em pescoço, ombros e lombar nos últimos 12 meses e ombros e lombar nos últimos 7 dias para indivíduos com jornadas de trabalho diárias superiores a 12 horas. Conclusões: A população estudada apresentou elevada carga mental de trabalho e alta prevalência de distúrbios musculoesqueléticos, bem como características profissionais preditoras de prejuízos à saúde física e mental.

"I Wish This Tool Was Available to Me Sooner": Piloting a Workplace Autism Disclosure Decision-Aid Tool for Autistic Youth and Young Adults.

Background: For autistic youth and young adults, deciding whether to disclose their autism at work may be complex since they are newly entering the workforce and are at an impressionable developmental period. Decision-aid tools can help someone make a choice regarding a topic/situation. We developed a workplace autism disclosure decision-aid tool called DISCLOSURE (Do I Start the Conversation and Let On, Speak Up, and REveal?) to support autistic youth and young adults navigate disclosure decision-making. In this study, we aimed to assess the DISCLOSURE tool's (1) impact on decision-making and self-determination capabilities and (2) usability, feasibility, and acceptability. Methods: This was a single-arm pre-post pilot study. The DISCLOSURE tool comprises three interactive PDF documents and videos. Thirty participants (mean age of 23.5 years) completed online surveys before and after interacting with the DISCLOSURE tool. We used descriptive statistics for usability, feasibility, and acceptability. We calculated the Wilcoxon signed rank and paired t-tests to determine pre-post changes in decision-making and self-determination capabilities (Decisional Conflict Scale-Low Literacy Version [DCS-LL]; adapted Arc's Self-Determination Scale). We analyzed open-ended data using conventional (inductive) content analysis. Results: There were significant decreases in DCS-LL total and subscale scores (p < 0.0001) and a significant increase in Arc's total score (p = 0.01), suggesting important improvements. There were no significant increases for Arc's psychological empowerment and self-realization subscales (p = 0.05; p = 0.09). Median scores (4.0/5.0) indicate that participants agreed that the DISCLOSURE tool is acceptable, feasible, and meets the usability criteria. We developed four categories to describe the open-ended data: (1) disclosure capabilities, (2) the role of others, (3) positive tool impact and feedback, and (4) minimal tool impact and constructive feedback. Discussion: Findings are suggestive of the DISCLOSURE tool's ability to support workplace autism disclosure decision-making. Future studies should ascertain the DISCLOSURE tool's effectiveness, explore others' feedback (e.g., employers), and how to incorporate the tool into relevant employment and vocational programs.

Why is this topic important? Autistic youth and young adults face a dilemma when starting their first jobs: should they disclose their autism at work? This is a complicated decision and involves considering many factors, benefits, and risks. Our team developed a decision-aid tool to help with this decision-making process called DISCLOSURE (Do I Start the Conversation and Let On, Speak Up and REveaL?). This study is important because it is the first to assess the DISCLOSURE tool and explore if it may be helpful. What is the purpose of this article? This study had two main goals. First, we assessed if the DISCLOSURE tool helps to build self-determination and decision-making knowledge, skills, and confidence. Second, we explored if participants thought that the DISCLOSURE tool is usable, acceptable, and can be used in the real world (feasible). What did the researchers do? We recruited 30 participants (average age of 23.5 years) to complete two online surveys­one before and one after using the DISCLOSURE tool. We analyzed the data to observe if there were changes in decision-making and self-determination knowledge, skills, and confidence. We also explored how participants rated the acceptability, feasibility, and usability of the DISCLOSURE tool. We read through open-ended answers to group them into categories. What did the researchers find? We found important improvements in participants' decision-making knowledge, skills, and confidence. The DISCLOSURE tool shows promise to improve self-determination. Participants agreed that the DISCLOSURE tool is usable, acceptable, and feasible. Many participants said that the DISCLOSURE tool can help them make disclosure decisions at work. Some participants said that the tool was not as helpful for them. This is because they already had disclosure knowledge and experience. Overall, the study results suggest that the tool may support some autistic young people with the disclosure decision-making process. What do these findings add to what is already known? Few tools exist that support disclosure decision-making. Research also shows that young autistic people find it hard to make autism disclosure decisions at work and may need help. This study is the first to assess a tool that may close important gaps and help autistic young people make disclosure choices. What are potential weaknesses in the study? We need to continue testing the DISCLOSURE tool since this is the first time that we assessed it. We also missed some important perspectives in this study. Most participants were white, cisgender women, or nonbinary from Ontario, Canada, and needed internet and a tech device to take part. How will these findings help autistic young people now or in the future? Results show that the DISCLOSURE tool may help autistic youth and young adults make disclosure choices at work. We will continue to assess the DISCLOSURE tool to make sure it is effective. Autistic youth and young adults could use the DISCLOSURE tool in the future to help guide their disclosure choices at work. Relevant service providers could also use the DISCLOSURE tool with their autistic clients.

The effect of organizational silence on the relationship between workplace ostracism and nurses' procrastination behavior: A structural equation modeling.

AIM: This study aims to assess the relationship between workplace ostracism and the procrastination behavior of nurses, as well as examine the effect of organizational silence on this relationship. BACKGROUND: Controlling workplace ostracism and eradicating time wasters, especially procrastination behavior among nurses, are key strategies that add value to organizational effectiveness. In addition, remaining silent about significant issues facing nurses is a devastating approach to the success of both healthcare organizations and the nursing profession. METHOD: A cross-sectional descriptive correlational exploratory research design was used to conduct the study. Data were collected from 352 nurses recruited from three large university hospitals in Alexandria, Egypt. Four instruments, namely, the Workplace Ostracism Questionnaire, the Organizational Silence Scale, the Active Procrastination Scale, and the Unintentional Procrastination Scale, were used. Structural equation modeling was used to test the hypothesized relationships among the variables. RESULTS: The findings demonstrated a significant positive and moderate association between workplace ostracism and both active and passive procrastination behaviors among nurses. Moreover, there was a strong positive and significant correlation between organizational silence and workplace ostracism. The results of mediation revealed that the indirect effect of workplace ostracism on both active and passive procrastination behavior through organizational silence was statistically significant, suggesting that organizational silence partially mediated this relationship. CONCLUSION: The study highlighted the ongoing challenges posed by toxic workplace issues, such as organizational ostracism and silence, as significant factors contributing to nurses' procrastination behaviors. Not only do these factors directly impact nurses' productivity, but they also interact to exacerbate negative outcomes in nursing care. Addressing these toxic dynamics is critical to improving nurse performance and ensuring quality care in healthcare settings. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study offers new insights for navigating toxicity and upgrading nursing productivity in healthcare organizations through fostering a more inclusive and communicative work environment. Promoting team cohesion and ensuring that all staff members feel valued and included can reduce feelings of isolation that may lead to procrastination. Also, creating safe spaces for nurses to voice concerns without fear of reprisal could significantly diminish passive procrastination, which ultimately enhances overall patient care quality and organizational efficiency.

Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause. METHODS: A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College. RESULTS: Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence. CONCLUSIONS: The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.

Exploring Emotional Well-Being and Support of Midwives Who Provide Termination of Pregnancy Care: An International Survey.

AIMS: Assess the psychological impact that providing TOP care beyond 12 weeks gestation has on midwives in Australia and New Zealand, improve understanding of TOP care and explore what support midwives have and what they might need to deal with their work experiences. DESIGN: Online survey. METHODS: A web-based, self-reported questionnaire with a total of 63 questions collected data from June to October 2022. Two validated psychometric tools were included to assess emotional well-being. Numerical data were analysed using descriptive statistics, frequencies, percentages and means. The STROBE guideline was used for reporting. RESULTS: Most midwives felt unsupported and affected by their experiences of providing termination of pregnancy care. Recognition and regular post-care debriefing with management were minimal. Lack of staff impacted the ability to provide individualised care. Mental health support was not commonly offered to midwives. Psychometric tools showed burnout and high levels of compassion fatigue, but also compassion satisfaction. To feel supported midwives need a fully staffed workforce, the ability to provide one-on-one care, recognition from managers and team support. CONCLUSION: Midwives who deliver termination of pregnancy care are unsupported and at high risk of burnout and compassion fatigue. Providing appropriate support is vital to increase midwives' well-being and sustain women's access to safe, high-quality care. IMPACT: Study addresses a knowledge gap about midwives' support needs when caring for women undergoing termination of pregnancy beyond 12 weeks. Findings show the urgent need to recruit and retain midwifery staff, acknowledge the mental health risks of termination of pregnancy care and implement mental health strategies for midwives. Research benefits midwives who provide termination of pregnancy care, midwife managers, healthcare organisations and professional bodies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Workplace dignity scale in Iranian nurses: translation and psychometric evaluation.

BACKGROUND: Workplace dignity is defined as a person's perception of respect and trust, equal and fair treatment, valuing the person, independence, freedom of expression, and decision-making enjoyed by the employee in the workplace. Therefore, this study aimed to develop the Workplace Dignity Scale (WDS) and evaluate its psychometric properties. METHODS: In this methodological study, WDS was translated based on Beaton et al. Guideline. After assessing face and content validity (using CVI, CVR, modified kappa, and item impact), 250 nurses were selected by random sampling from Kashan hospitals in 2023. Then, WDS was assessed through expletory factor analysis (EFA), known-groups comparison, internal consistency, and stability. The ceiling and floor effects were also examined. Data were analyzed using SPSS v16 by Kruskal-Wallis test, Cronbach's alpha, McDonald's Omega, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable changes (MDC). RESULTS: The scale's CVI, CVR, and modified kappa were above 0.79. Item impact was higher than 1.5. EFA extracted three factors, including "general dignity, respect, and indignity", that could explain 70.6% of the total variance in scale. WDS could differentiate between the three groups in terms of occupation satisfaction status. Cronbach's alpha, McDonald's Omega, ICC, SEM, and STC of scale were 0.949, 0.950, 0.970, 2.793, and 7.742, respectively. CONCLUSION: The Persian version of the WDS has shown validity and reliability for measuring workplace dignity among nurses in the Iranian context.

Inclusive leadership and employee workplace well-being: the role of vigor and supervisor developmental feedback.

PURPOSE: Employees within organizations actively pursue and maintain their workplace well-being. Although there are current studies that have examined the linking inclusive leadership to employee workplace well-being, the underlying intrinsic link between the two remains unclear. On the basis of self-determination theory, this research examined the relationship between inclusive leadership, vigor, supervisor developmental feedback, and workplace well-being. PATIENTS AND METHODS: Data were collected from 61 teams that totaled 342 full-time employees through a 3-stage questionnaire. Multilevel Structural Equation Modeling and Monte Carlo simulations were conducted on data for hypothesis testing. RESULTS: Inclusive leadership positively correlated with employee workplace well-being. Employee vigor mediates the link between inclusive leadership and employee workplace well-being. Supervisor developmental feedback moderated the relationship between inclusive leadership and employee vigor. CONCLUSIONS: Inclusive leadership can improve employees' workplace well-being by stimulating their vigor. Therefore, managers need to be able to effectively meet employees' basic needs to stimulate their vigor. Based on meeting employees' basic needs, managers can also provide targeted developmental feedback to meet employees' growth needs, which can more effectively promote employees' vigor and workplace well-being.

The Prevalence of Burnout in Limb Lengthening and Reconstruction Surgeons.

Aim: To evaluate the level of burnout among international limb reconstruction surgeons. Background: Burnout describes chronic workplace stress that has not been successfully managed. Limb reconstruction surgeons may be particularly at risk for burnout. The development of necessary skills and expertise has a steep learning curve and the patients are among the most complex in orthopaedics, with multiple failed surgeries and high complication rates. Methods: An internet-based REDCap survey consisted of demographic questions, four open-ended questions, and two valid, reliable measures: (1) Patient Health Questionnaire 4 (PHQ-4)-a screening tool for anxiety and depression, and (2) The Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP) which measures levels of depersonalization, emotional exhaustion, and low personal achievement. The surveys were distributed to international limb reconstruction surgeons. Statistical analysis consisted of descriptive and non-parametric analysis: Chi-square and Kruskal-Wallis tests. Results: There were 103 surgeon responses from at least one country of each of the six populated continents. Eighty-three percent of the respondents were male. The career level distribution was early (1-10 years' experience) = 51%, mid (11-20 years' experience) = 30%, and late (>20 years' experience) = 20%. Twenty-four percent stated they were currently being treated or had been treated in the past for mood or anxiety or both with medication or counselling. Based on the MBI-HSS-MP scores, 38% of limb reconstruction surgeons displayed burnout symptoms, and 16% exhibited severe burnout. The mid-career had the highest levels of overall burnout; there was no statistical significance between the groups. The PHQ-4 scores were within normal limits. Discussion: In this study sample, 38% displayed burnout symptoms and 16% exhibited severe burnout. The mid-career group had the highest level of burnout. Clinical significance: Unmanaged burnout can lead to major depression or suicidal ideation, or both. Support systems for limb reconstruction surgeons need to be developed and maintained. How to cite this article: Iobst C, Tulchin-Francis K, Richard HM. The Prevalence of Burnout in Limb Lengthening and Reconstruction Surgeons. Strategies Trauma Limb Reconstr 2024;19(2):67-72.

Precision prevention in occupational health: a conceptual analysis and development of a unified understanding and an integrative framework.

Introduction: Precision prevention implements highly precise, tailored health interventions for individuals by directly addressing personal and environmental determinants of health. However, precision prevention does not yet appear to be fully established in occupational health. There are numerous understandings and conceptual approaches, but these have not yet been systematically presented or synthesized. Therefore, this conceptual analysis aims to propose a unified understanding and develop an integrative conceptual framework for precision prevention in occupational health. Methods: Firstly, to systematically present definitions and frameworks of precision prevention in occupational health, six international databases were searched for studies published between January 2010 and January 2024 that used the term precision prevention or its synonyms in the context of occupational health. Secondly, a qualitative content analysis was conducted to analyze the existing definitions and propose a unified understanding. Thirdly, based on the identified frameworks, a multi-stage exploratory development process was applied to develop and propose an integrative conceptual framework for precision prevention in occupational health. Results: After screening 3,681 articles, 154 publications were reviewed, wherein 29 definitions of precision prevention and 64 different frameworks were found, which can be summarized in eight higher-order categories. The qualitative content analysis revealed seven themes and illustrated many different wordings. The proposed unified understanding of precision prevention in occupational health takes up the identified themes. It includes, among other things, a contrast to a "one-size-fits-all approach" with a risk- and resource-oriented data collection and innovative data analytics with profiling to provide and improve tailored interventions. The developed and proposed integrative conceptual framework comprises three overarching stages: (1) data generation, (2) data management lifecycle and (3) interventions (development, implementation and adaptation). Discussion: Although there are already numerous studies on precision prevention in occupational health, this conceptual analysis offers, for the first time, a proposal for a unified understanding and an integrative conceptual framework. However, the proposed unified understanding and the developed integrative conceptual framework should only be seen as an initial proposal that should be critically discussed and further developed to expand and strengthen both research on precision prevention in occupational health and its practical application in the workplace.

Evaluation of a Workplace Diabetes Prevention Program Delivered via Distance Learning: A Qualitative Study.

Little is known about how distance learning impacts delivery of the National Diabetes Prevention Program (DPP) despite a rapid shift to this platform during the coronavirus disease 2019 (COVID-19) public health emergency. We explored how a workplace DPP, delivered via distance learning, impacted knowledge, motivation, and behavioral skills of participants throughout the program. We conducted repeated qualitative interviews with distance learning participants at baseline, 6 months, and 12 months from September 2020 to July 2022. Three study team members coded interview data using individual responses as the unit of analysis. We used a thematic approach, using the information-motivation-behavioral skills framework, to analyze responses and generate understanding of the program's impact. The 27 individuals who participated in the interviews (89% women, mean age 56 years) reported the distance learning platform was effective in changing their behavior. The program's focus on food logging and setting limits on specific types of caloric intake was perceived as essential. Education on ideal levels of fat and sugar consumption, lessons on how to read food labels, and dissemination of recipes with healthy food substitutions allowed participants to initiate and sustain healthy decision-making. Strategies to increase physical activity, including breaking up exercise throughout the day, made reaching their goals more feasible. Participants reported food logging and weight reporting, as well as group support during sessions, either sustained or increased their motivation to adhere to the program over time. A workplace DPP delivered via distance learning successfully prompted improvements in the knowledge, motivation, and behavioral skills necessary to increase healthy eating and physical activity among participants.

Risky Business. Interventions to Prevent Aggression Against Health Workers From Patients at Risk: An Integrative Review.

AIM: To identify best practices to prevent violence against healthcare workers by patients at risk for aggression in the adult inpatient setting. DESIGN: An integrative review. METHODS: Conducted using the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals Model. Title and abstract screening on 4186 articles resulted in 156 for full text review. Full text screening yielded 14 articles that met inclusion criteria. DATA SOURCES: A search of the databases PubMed, CINAHL, Embase, and JBI from January 2019 to February 2023. RESULTS: The review revealed behavioural intervention teams, environmental changes, and coordinated communication plans were the most used strategies, however none demonstrated significant decreases in violence. CONCLUSIONS: Health systems can implement strategies shown to decrease the incidence of violence in healthcare settings globally. Lack of consistency in the evidence suggests the need for further research to assess mitigating strategies for violence against healthcare workers in inpatient hospital settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patient safety is a cornerstone of nursing practice; however, healthcare workers need to feel safe in their work environment. Violent events are chronically underreported, ill defined, and when reported, do not address change in the practice setting. Identifying strategies to address escalating behaviour before it results in violence is crucial for everyone's safety. IMPACT: This integrative review exposes the scarcity of evidence available to address rising concerns about patients on healthcare provider violence (Type II) in the workplace. Although several assessment tools for identifying violent patients exist, evidence regarding prevention is woefully absent. The review highlights potential interventions for further study to equip healthcare workers to manage patients safely and effectively before an escalation occurs. REPORTING METHOD: PRISMA checklist for integrative reviews. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was part of this review.

Development of a breastfeeding support scale in the workplace and psychometric properties of Turkish version: a validity and reliability.

The purpose of this study was to develop a workplace breastfeeding support scale for working mothers and examine their psychometric properties. This methodological research was conducted between February and April 2022. This study included 325 mothers who continued breastfeeding while working. The tool development stages included item generation, expert review for content validity testing, and psychometric testing. The data were collected through face-to-face interviews between February and April 2022. In data analysis, for explanatory factor analysis, the direct oblimin technique and scree plot test were performed. Structural equation modeling was performed for confirmatory factor analysis. Two sub-dimensions (manager support, environmental support) and a nine-item workplace breastfeeding support scale showed good validity and reliability. The Cronbach's alpha value of the total scale and sub-dimensions of the scale were greater than 0.70. Confirmatory factor analysis showed that the model fit indices were acceptable (χ2 = 68.658, χ2/df = 2.64, CFI = 0.94, GFI = 0.96, AGFI = 0.92, and RMSEA = 0.07). The total variance explained by the scale was 54.32 percent. This newly developed 9-item and 2-dimensional version is a valid and reliable tool for measuring the working mothers' perception of workplace breastfeeding support. This tool is recommended to be verified in other low, middle, and high-income countries.

Nothing personal, it's the organization! Links between organizational culture, workplace bullying, and affective commitment.

Extensive attention in organizational research has been dedicated to workplace bullying, primarily focusing on its frequency and impact on both the victim and the bully, emphasizing interpersonal dynamics. This study extends current research by shifting the focus to the organizational level, examining the relationship between organizational culture and affective commitment, mediated by workplace bullying. Utilizing data from two surveys (N = 650 in 2012 and N = 553 in 2017), the study reveals that dimensions of organizational culture, such as assertiveness, performance orientation, and ingroup collectivism significantly influence work-related workplace bullying. Performance orientation and assertiveness are positively associated with increased bullying, whereas ingroup collectivism serves as a deterrent. In turn, work-related bullying negatively impacts affective commitment, while a culture characterized by high ingroup collectivism not only links negatively with bullying but also links positively with affective commitment. This work is one of the first studies to investigate the interplay among several dimensions of organizational culture, workplace bullying, and affective commitment, underscoring the importance of supportive organizational cultures in fostering healthy work environments.

Workplace Violence against Emergency Medical Services (EMS): a prospective 12-month cohort study evaluating prevalence and risk factors within a large, multistate EMS agency.

OBJECTIVES: To determine the prevalence and associated risk factors of workplace violence (WPV) experienced by emergency medical services (EMS) clinicians across a large, multistate ground/air EMS agency. METHODS: We used a prospective cohort study design from 12/1/2022-11/30/2023. A checkbox was added within the electronic medical record (EMR) asking staff to indicate whether WPV occurred. Patient characteristics, encounter (run), and crew factors were abstracted. Potential risk factors for WPV were assessed using logistic regression, with the occurrence of any form of violence as the primary outcome of interest. Models were both univariable, assessing each risk factor individually, and multivariable assessing all risk factors together to identify independent factors associated with higher risk of WPV. Multivariable model results were reported using odds ratios (aORs) and 95% confidence intervals. RESULTS: A total of 102,632 runs were included, 95.7% (n= 98,234) included checkbox documentation. There were 843 runs (0.86 per 100 runs, 95% CI 0.80-0.92) identified by EMS clinicians as WPV having occurred, including verbal abuse (n= 482), physical assault (n= 142), and both abuse and assault (n= 219). Risk factors for violence included male patient gender (aOR 1.45, 95% CI 1.24 - 1.70, p <0.001), Richmond Agitation-Sedation Scale (RASS) >1 (aOR 16.97, 95% CI 13.71 - 21.01, p < 0.001), and 9-1-1 runs to include emergent (P1; aOR 1.75, 95% CI: 1.17-2.63, p = 0.007) and urgent (P2; aOR 1.64, 95% CI 1.08-2.50, p = 0.021) priority, compared to P3/scheduled transfer or P4/trip requests. Factors associated with lower risk for violence included older patients (aOR per 10 years = 0.95, 95% CI 0.91 - 0.98, p = 0.007) and run time of day between 0601-1200 hours compared to 0000-0600 hours (aOR 0.67, 95% CI 0.51 - 0.88, p = 0.004). Only 2.7% of violent runs captured through the EMR were reported through official processes. CONCLUSIONS: Verbal and/or physical violence is recognized in nearly 1% of EMS runs. We recommend prioritizing WPV prevention and mitigation strategies around identified risk factors and simplifying the WPV reporting process in order to reduce staff administrative burden and encourage optimal capturing of violent events.

National implementation trial of BeUpstanding™: an online initiative for workers to sit less and move more.

BACKGROUND: The online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding. METHODS: Recruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described. RESULTS: Of the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program. CONCLUSIONS: BeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability. TRIAL REGISTRATION: ACTRN12617000682347.

Staff Safety Alert Banner Program Against Workplace Violence at an Urban American Hospital.

BACKGROUND: Workplace violence (WPV) in healthcare has become an issue worldwide, with increasing prevalence after the COVID-19 pandemic. Notably, WPV in any setting has individual and systemic repercussions. However, despite extensive literature reporting the prevalence of WPV in healthcare worldwide, effective, standardized prevention policies have not been established. We developed and piloted a WPV initiative at an urban hospital in the state of Maryland. Here, we aim to describe our program development methods and implementation. METHODS: The 6-month program utilized a reporting tool developed within patients' electronic medical records (EMRs) to request the display of a Staff Safety Alert (SSA) banner to alert healthcare professionals of patients who engaged in violent behavior and are at increased risk of subsequent behavior. This tool was piloted on 21 patient care units. A review committee either approved or denied case requests filed by frontline workers, with holistic consideration involving patient status, potential biases, and communication flaws. RESULTS: Twenty-one banner requests were filed during the course of the pilot. Of which, eight were approved, and 13 were denied. The multi-trauma intermediate care floor filed the most case requests for a safety banner. CONCLUSIONS/APPLICATION TO PRACTICE: Our pilot program offers a patient-centered intervention program where extensive personnel training and patient-focused considerations were applied prior to the approval or denial of a banner display. The SSA program was the initial step in institutionally combatting WPV in healthcare as staff are encouraged to officially document unsafe events followed by careful action in response.

Aggressive Behaviour Risk Assessment Tool for Hospitalised Patients in Non-Psychiatric Inpatient Units.

AIM: To refine and validate an electronic version of the Aggressive Behaviour Risk Assessment Tool (ABRAT) and determine the sensitivity and specificity for identifying potentially violent patients in non-psychiatric inpatient units. DESIGN: A prospective cohort study design was used. METHODS: All patients admitted or transferred to three inpatient units of an acute care hospital in Nebraska, USA, from 7 February to 9 April 2023, were included. The 10-item ABRAT assessments were performed daily for the first 3 days of admission. The violent events were collected until discharge in three categories: Physical aggression towards others, physical aggression towards property and verbal intimidation/threat towards others. Kendall's tau tests and a multivariate logistic regression procedure were performed to select a parsimonious set of items that best predict violent events. RESULTS: Of 1179 patients, 69 had ≥1 violent event (5.9%). The revised six-item tool with item weighting was named ABRAT for Hospitalised Patients (ABRAT-H). The area under the curve from the Receiver Operating Characteristics analysis was 0.82. The sensitivity and specificity at a cutoff score of two were 68.1% and 85.2%, respectively. As ABRAT-H scores increased, the percentage of violent patients also increased and for patients with scores ≥5, 55.2% became violent. CONCLUSION: ABRAT-H appears to be useful for identifying potentially violent patients in non-psychiatric inpatient units with satisfactory sensitivity and specificity. IMPLICATIONS FOR PATIENT CARE: The availability of ABRAT-H may help provide focused preventive measures that target patients at high risk for violence and reduce violent events. IMPACT: A majority of the nursing workforce is employed in acute care hospital setting, and the availability of ABRAT-H can further enhance the culture of a safe work environment and have positive impacts not only on the nurses' physical and mental health but also on the quality of patient care. REPORTING METHOD: We have adhered to relevant STROBE guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.