The Demand-Control model and work-related threats and violence: Short- and long-term associations.

BACKGROUND: Work-related violence and threats are frequent in human service sectors. Although previous studies have identified several psycho-social work environmental risk factors for work-related violence and threats, the research domain still remains mainly descriptive and non-theoretical in nature. OBJECTIVE: Using the Job-Demands-Control model we analysed the relationship between the psycho-social work environment and work-related threats and violence. METHOD: Using a two-wave (2011 and 2015) longitudinal study of 2678 participants, we analysed the main and interactive effects of quantitative demands and job control on exposure to work-related violence and threats. RESULTS: High work demands and low job-control were associated with elevated risk of work-related threats in 2011 and in 2015. The associations of work demands and job control and work-related violence were mixed. There were not statistically significant interaction effects between high demands and low job control on neither work-related violence nor threats. CONCLUSION: In sectors where work-related threats and violence are likely to occur, risk prevention may also require improving the work conditions for employees, more specifically by reducing work-demands and increasing job control for instance by differentiating between important and less important work demands and by implementing self-autonomous work-teams may be a way to increase job control.

A longitudinal study of the possible escalation of aggressive behaviors - from bullying and conflicts to workplace violence. Is emotional exhaustion a mediator?

BACKGROUND: Aggression theories and cross-sectional studies imply an escalatory pattern of aggressive behaviors; however, this has not been investigated in a follow-up study. OBJECTIVE: To investigate whether bullying or conflicts are antecedents of threats and physical violence, and whether threats mediate the relationship between bullying or conflicts and violence. Lastly, it was explored whether associations could be explained through the effect of emotional exhaustion. METHODS: Survey data was collected from a follow-up sample of 3,584 employees from four human service sectors, namely psychiatry, special schools, eldercare, and the prison and probation services. The main analysis uses hierarchical logistic regression. RESULTS: The analyses showed that frequent /intense conflicts, not bullying, at baseline were significantly related to higher exposure rates of threats (OR = 4.98, CI = [3.19-7.76]) and violence (OR = 3.01, CI = [1.96-4.76]) at follow-up. Emotional exhaustion was not confirmed as a substantial mediator. However, the proportion mediated by threats was significant (70%) for the relationship between frequent /intense conflicts and violence. CONCLUSION: This study finds that aggressive workplace behaviors may indeed escalate, particularly within a similar victim-perpetrator relationship, such as between employees and clients. The study highlights the need for de-escalation techniques that transcend specific encounters, recognizing that aggressive behavior may escalate over time.

Design of a tailored and integrated violence prevention program in psychiatric wards and prisons.

BACKGROUND: Violence and threats of violence against personnel at psychiatric wards as well as in the prison service is a major work environment problem. To date results from interventions to prevent violence and threats in these sectors have been inconclusive or of small effect. One of the reasons may be that violence and threats of violence occur as a consequence of a complex interaction between employee-level and management-level factors. OBJECTIVE: To design a tailored and theory-based intervention program directed at violence prevention in psychiatric wards and prisons that integrates the employee-level and management-level, and development of an evaluation design building on the Context, Process, and Outcome Evaluation Model. METHODS: The study follows a stepped-wedged design with 16 work units entering the intervention in four groups with differing start dates from September 2017 to January 2019. The context and process evaluation includes: calculating the implementation degree; mapping of contextual factors; interviews with unit-leaders and employees before and after the intervention. The outcome evaluation includes performing multi-level statistical analysis on data from a three-monthly questionnaire to employees at the participating workplaces. RESULTS: The first results will be available in 2020. CONCLUSIONS: The comprehensive evaluation of the intervention will give insight into the processes and effects of the intervention.

Employees exposed to work-related threats and violence in human services sectors: Are any employees members particularly exposed to violence and threats and what role do supervisors play?

BACKGROUND: The frequency of being exposed to work-related violence and threats is high in employees working in the human service sector. The question is whether certain employees are particularly exposed to violence and threats than others. OBJECTIVE: This study examined whether particular employees were especially exposed to work-related violence and threats due to personal characteristics, coping styles, attitudes or participating in violence prevention training. We also examined the role played by supervisors. METHODS: Questionnaire data were collected in 2010 and 2011. In all, 3584 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Service participated. We used multivariate logistic regression analyses. RESULTS: We found persons high on the extroversion and introversion scales were associated with statistical significant increased risk for work-related threats. Furthermore, accepting attitudes concerning work-related violence were also statistical significant associated with increased the risk for both work-related threats and violence. Associations between coping styles and work-related threats and violence were very small and statistically non-significant and we found no effect of violence prevention training. The risk for work-related threats for persons high on the extroversion scale was decreased if supervisor violence prevention behaviour was high. Furthermore, if supervisor prevention behaviour was high, prevention training decreased the risk for work-related violence. However, these associations weren't statistically significant. CONCLUSION: The results stress that effective prevention requires involvement of both employees and supervisors.

Work-related threats and violence in human service sectors: The importance of the psycho-social work environment examined in a multilevel prospective study.

BACKGROUND: Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management. OBJECTIVE: The purpose of this study was to identify prospective associations between psycho-social work environment and work-related threats and violence in four high risk human service sectors. METHODS: Questionnaire data was collected from 3011 employees working at psychiatric wards, in the elder sector, in the Prison and Probation Service and at Special Schools. Associations between psycho-social work environment and work-related violence and threats were then studied using a one-year follow-up design and multilevel logistic regression analyses. RESULTS: The analyses showed that quantitative demands, high emotional demands, low level of influence over own work-situation, low predictability, low rewards at work, low role clarity, many role conflicts, many work-family conflicts and low organizational justice had statistically significant associations with high levels of work-related threats. Furthermore, high emotional demands, low predictability, low role clarity, many role conflicts, many work-family conflicts, low supervisor quality and low support from nearest supervisor had statistically significant associations with high levels of work-related violence. Finally, across the four sectors both similar and different associations between psycho-social work environment and work-related violence and threats were found. CONCLUSION: The results of the study underline the importance of including the psycho-social work environment as a supplement to existing violence prevention methods and interventions aimed at reducing work-related violence and threats.

Effects of Violence Prevention Behavior on Exposure to Workplace Violence and Threats: A Follow-Up Study.

This longitudinal study investigates the relationship between prevention behaviors, that is, enacted violence prevention policies, and exposure to workplace violence and threats across four different high risk work sectors: psychiatry, special schools, eldercare, and the prison and probation services. Logistic regression analysis of a 1-year follow-up sample of 3.016 employees from these four sectors shows that prevention behaviors are significantly and negatively associated with self-reported exposure to workplace violence and threats-in the prison and probation services, eldercare, and in psychiatry, while no significant associations are found for special schools. The results therefore show clear sector differences with regard to the preventive effect of violence prevention behaviors. Furthermore, this multisector comparison suggests that prevention behaviors are more effective in relation to a moderate frequency of violence and threats, and that only top management prevention behavior can prevent very frequent incidents (odds ratio [ OR] = 0.58). This study contributes to the literature by use of a longitudinal design and acceptable response rates, while also simultaneously investigating several high risk sectors. The results imply that when managing workplace violence in high risk areas of human service work, there should be emphasis on the use of violence prevention behaviors from top management, supervisor, and among coworkers. However, type of sector and the frequency of workplace violence should be analyzed to evaluate the potential impact of prevention behaviors.

Burnout among Danish prison personnel: A question of quantitative and emotional demands.

Objectives The objective of this follow-up study was to investigate associations between individual, occupational and work environment factors and burnout among both uniformed and non-uniformed personnel working in the Danish Prison and Probation Service. Methods The participants (N = 4808) with client contact received a questionnaire in 2010 and again in 2011. In 2010, 2843 participants responded to the questionnaire (59.1%), and in 2011, 1741 responded to the questionnaire, yielding a response rate of 61.2% of the baseline population, and 36.2% of the invited population. Burnout and work characteristics were measured with validated scales from the Copenhagen Psychosocial Questionnaire, and data was analysed by logistic regression. Results Risk factors with the highest impact on burnout were work environmental factors: quantitative demands, emotional demands, involvement in and meaning of work. Role conflict, role clarity, social support and demands for hiding emotions had borderline significance. Besides cohabitation, there was no association between individual factors and burnout or between occupational characteristics and burnout. Moreover, there was no association between exposure to threats and violence and burnout. CONCLUSIONS: Efforts for preventing burnout ought to be concentrated on reducing the quantitative job-demands, on easing and improving staff-inmate relationships, but also on involvement in and meaning of work. Most work in prison is invisible and the overall goals are in conflict with each other. Management must provide solutions to problems of role conflict and support groups for social support. There is a risk of burnout among both uniformed personnel and non-uniformed personnel working in both open and closed facilities.