| 1. |
- Arnetz, Judith E., et al.
(author)
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Patient Involvement : A New Source of Stress in Health Care Work?
- 2016
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In: Health Communication. - : Informa UK Limited. - 1041-0236 .- 1532-7027. ; 31:12, s. 1566-1572
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Journal article (peer-reviewed)abstract
- Patients have become increasingly well informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers' partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N=488, response rate 67%). The sample was comprised of registered nurses (RNs, n=303), licensed practical nurses (LPNs, n=132), and physicians (MDs, n=53). Confirmatory factor analysis was used to examine seven questionnaire statements concerning implications of patient involvement for one's clinical work. Regression analyses were used to examine factors associated with staff's partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negativeHasslesand positiveUpliftsaspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress.
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| 2. |
- Hamblin, Lydia E., et al.
(author)
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Catalysts of worker-to-worker violence and incivility in hospitals
- 2015
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:17-18, s. 2458-2467
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Journal article (peer-reviewed)abstract
- Aims and objectivesTo identify common catalysts of worker-to-worker violence and incivility in hospital settings. BackgroundWorker-to-worker violence and incivility are prevalent forms of mistreatment in healthcare workplaces. These are forms of counterproductive work behaviour that can lead to negative outcomes for employees, patients and the organisation overall. Identifying the factors that lead to co-worker mistreatment is a critical first step in the development of interventions targeting these behaviours. DesignRetrospective descriptive study. MethodsQualitative content analysis was conducted on the total sample (n=141) of employee incident reports of worker-to-worker violence and incivility that were documented in 2011 at a large American hospital system. ResultsMore than 50% of the incidents involved nurses, and the majority of incidents did not involve physical violence. Two primary themes emerged from the analysis: Work Behaviour and Work Organisation. Incidents in the Work Behaviour category were often sparked by unprofessional behaviour, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance. Incidents in the Work Organisation category involved conflicts or aggression arising from failure to following protocol, patient assignments, limited resources and high workload. ConclusionIncidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behaviour or from organisational practices or work constraints. These incident descriptions reflect worker dissatisfaction and frustration, resulting from poor communication and collaboration between employees, all of which threaten work productivity. Relevance to clinical practiceViolence and incivility between hospital employees can contribute to turnover of top performers, hinder effective teamwork and jeopardise the quality of patient care. Identification of common catalysts for worker-to-worker violence and incivility informs the development of mistreatment prevention programmes that can be used to educate hospital staff.
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| 3. |
- Wright, A. Michelle, et al.
(author)
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Determinants of resource needs and utilization among refugees over time
- 2016
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 51:4, s. 539-549
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Journal article (peer-reviewed)abstract
- This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.
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| 4. |
- Wright, A. Michelle, et al.
(author)
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Kidnapping and Mental Health in Iraqi Refugees : The Role of Resilience
- 2017
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In: Journal of Immigrant and Minority Health. - : SPRINGER. - 1557-1912 .- 1557-1920. ; 19:1, s. 98-107
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Journal article (peer-reviewed)abstract
- Although kidnapping is common in war-torn countries, there is little research examining its psychological effects. Iraqi refugees (N = 298) were assessed upon arrival to the U.S. and 1 year later. At arrival, refugees were asked about prior trauma exposure, including kidnapping. One year later refugees were assessed for posttraumatic stress disorder (PTSD) and major depression disorder (MDD) using the SCID-I. Individual resilience and narratives of the kidnapping were also assessed. Twenty-six refugees (9 %) reported being kidnapped. Compared to those not kidnapped, those who were had a higher prevalence of PTSD, but not MDD, diagnoses. Analyses examining kidnapping victims revealed that higher resilience was associated with lower rates of PTSD. Narratives of the kidnapping were also discussed. This study suggests kidnapping is associated with PTSD, but not MDD. Additionally, kidnapping victims without PTSD reported higher individual resilience. Future studies should further elucidate risk and resilience mechanisms.
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| 5. |
- Wright, A. Michelle, et al.
(author)
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Unemployment in Iraqi refugees : The interaction of pre and post-displacement trauma
- 2016
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In: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 57:6, s. 564-570
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Journal article (peer-reviewed)abstract
- Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N=286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.
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| 6. |
- Arnetz, Judith E., et al.
(author)
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Patient involvement climate : views and behaviours among registered nurses in myocardial infarction care
- 2015
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:3-4, s. 475-485
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Journal article (peer-reviewed)abstract
- Aims and objectives. To introduce and define the patient involvement climate and measure its quality and strength via views and behaviours among nurses in coronary care units. Background. Patient involvement is receiving increased attention among health-care providers. To better understand and optimise the interpersonal dynamics of patient involvement, it is important to study the organisational context in which the patient-provider interaction occurs. Design. Cross-sectional, self-report questionnaire study. Methods. Registered nurses across 12 coronary care units (n = 303) completed a questionnaire reporting their views and behaviours regarding patient involvement. Analyses assessed climate quality (the positive or negative nature of nurses' perceptions) and climate strength (the degree of consensus within coronary care units). Results. Climate quality and strength were greatest for the dimensions measuring nurses' views of patient involvement, the nurse-patient information exchange process and nurses' responsiveness to patient needs. Climate quality and strength were weaker for the dimensions measuring nurses' views of the hindrances associated with patient involvement, discussion of daily activities and efforts to motivate patients to take responsibility for their health. In units with consensus that patient involvement poses hindrances, nurses were less likely to address patient needs. Conclusions. When nurses perceived patient involvement as less of a hindrance in their work, they were more responsive to patient needs. A patient involvement climate characterised by motivational behaviour among nurses was marked by better information exchange and discussion of suitable activities postdischarge. Relevance to clinical practice. Managers can capitalise on positive climate aspects by encouraging ward activities that facilitate active patient involvement among nurses. One suggestion is educational interventions at the workplace focused on reducing perceptions of patient involvement as a hindrance and encouraging the attitudes that it can enrich nursing work and patient outcomes.
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| 7. |
- Arnetz, Judith E., et al.
(author)
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Preventing Patient-to-Worker Violence in Hospitals : Outcome of a Randomized Controlled Intervention
- 2017
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In: Journal of Occupational and Environmental Medicine. - 1076-2752 .- 1536-5948. ; 59:1, s. 18-27
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Journal article (peer-reviewed)abstract
- Objective: To evaluate the effects of a randomized controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals. Methods: Forty-one units across seven hospitals were randomized into intervention (n = 21) and control (n = 20) groups. Intervention units received unit-level violence data to facilitate development of an action plan for violence prevention; no data were presented to control units. Main outcomes were rates of violent events and injuries across study groups over time. Results: Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared with controls (incident rate ratio [IRR] 0.48, 95% confidence interval [CI] 0.29 to 0.80). At 24 months, the risk for violence-related injury was lower on intervention units, compared with controls (IRR 0.37, 95% CI 0.17 to 0.83). Conclusions: This data-driven, worksite-based intervention was effective in decreasing risks of patient-to-worker violence and related injury.
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| 8. |
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| 9. |
- Arnetz, Judith E., et al.
(author)
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Underreporting of Workplace Violence Comparison of Self-Report and Actual Documentation of Hospital Incidents
- 2015
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In: Workplace Health & Safety. - : SAGE Publications. - 2165-0799 .- 2165-0969. ; 63:5, s. 200-210
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Journal article (peer-reviewed)abstract
- This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.
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| 10. |
- Arnetz, Judith E., et al.
(author)
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Understanding patient-to-worker violence in hospitals : a qualitative analysis of documented incident reports
- 2015
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 71:2, s. 338-348
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Journal article (peer-reviewed)abstract
- Aim. To explore catalysts to, and circumstances surrounding, patient-to-worker violent incidents recorded by employees in a hospital system database. Background. Violence by patients towards healthcare workers (Type II workplace violence) is a significant occupational hazard in hospitals worldwide. Studies to date have failed to investigate its root causes due to a lack of empirical research based on documented episodes of patient violence. Design. Qualitative content analysis. Methods. Content analysis was conducted on the total sample of 214 Type II incidents documented in 2011 by employees of an American hospital system with a centralized reporting system. Findings. The majority of incidents were reported by nurses (39.8%),security staff (15.9%) and nurse assistants (14.4%). Three distinct themes were identified from the analysis: Patient Behaviour, Patient Care and Situational Events. Specific causes of violence related to Patient Behaviour were cognitive impairment and demanding to leave. Catalysts related to patient care were the use of needles, patient pain/discomfort and physical transfers of patients. Situational factors included the use/presence of restraints; transitions in the care process; intervening to protect patients and/or staff; and redirecting patients. Conclusions. Identifying catalysts and situations involved in patient violence in hospitals informs administrators about potential targets for intervention. Hospital staff can be trained to recognize these specific risk factors for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behaviour. A social-ecological model can be adapted to the hospital setting as a framework for prevention of patient violence towards staff.
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| 11. |
- Arnetz, Judith E., et al.
(author)
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Using database reports to reduce workplace violence : Perceptions of hospital stakeholders
- 2015
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In: Work. - 1051-9815 .- 1875-9270. ; 51:1, s. 51-59
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Journal article (peer-reviewed)abstract
- BACKGROUND: Documented incidents of violence provide the foundation for any workplace violence prevention program. However, no published research to date has examined stakeholders' preferences for workplace violence data reports in healthcare settings. If relevant data are not readily available and effectively summarized and presented, the likelihood is low that they will be utilized by stakeholders in targeted efforts to reduce violence. OBJECTIVE: To discover and describe hospital system stakeholders' perceptions of database-generated workplace violence data reports. PARTICIPANTS: Eight hospital system stakeholders representing Human Resources, Security, Occupational Health Services, Quality and Safety, and Labor in a large, metropolitan hospital system. METHODS: The hospital system utilizes a central database for reporting adverse workplace events, including incidents of violence. A focus group was conducted to identify stakeholders' preferences and specifications for standardized, computerized reports of workplace violence data to be generated by the central database. The discussion was audio-taped, transcribed verbatim, processed as text, and analyzed using stepwise content analysis. RESULTS: Five distinct themes emerged from participant responses: Concerns, Etiology, Customization, Use, and Outcomes. In general, stakeholders wanted data reports to provide "the big picture," i.e., rates of occurrence; reasons for and details regarding incident occurrence; consequences for the individual employee and/or the workplace; and organizational efforts that were employed to deal with the incident. CONCLUSIONS: Exploring stakeholder views regarding workplace violence summary reports provided concrete information on the preferred content, format, and use of workplace violence data. Participants desired both epidemiological and incident-specific data in order to better understand and work to prevent the workplace violence occurring in their hospital system.
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| 12. |
- Flink, Håkan, et al.
(author)
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Patient-reported negative experiences related to caries and its treatment among Swedish adult patients.
- 2017
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In: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 17:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment.METHODS: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared.RESULTS: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients.CONCLUSIONS: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.
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| 13. |
- Hamblin, Lydia E., et al.
(author)
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Worker-to-Worker Violence in Hospitals Perpetrator Characteristics and Common Dyads
- 2016
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In: Workplace Health & Safety. - : SAGE Publications. - 2165-0799 .- 2165-0969. ; 64:2, s. 51-56
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Journal article (peer-reviewed)abstract
- Worker-to-worker (Type III) violence is prevalent in health care settings and has potential adverse consequences for employees and organizations. Little research has examined perpetrator characteristics of this type of violence. The current study is a descriptive examination of the common demographic and work-related characteristics of perpetrators of Type III workplace violence among hospital workers. Analysis was based on documented incidents of Type III violence reported within a large hospital system from 2010 to 2012. Nurses were involved as either the perpetrator or target in the five most common perpetrator-target dyads. Incidence rate ratios revealed that patient care associates and nurses were significantly more likely to be perpetrators than other job titles. By examining characteristics of perpetrators and common worker dyads involved in Type III workplace violence, hospital stakeholders and unit supervisors have a starting point to develop strategies for reducing conflict between workers.
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| 14. |
- Hamblin, Lydia E., et al.
(author)
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Worksite Walkthrough Intervention : Data-driven Prevention of Workplace Violence on Hospital Units
- 2017
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In: Journal of Occupational and Environmental Medicine. - : Wolters Kluwer. - 1076-2752 .- 1536-5948. ; 59:9, s. 875-884
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to describe the implementation of a data-driven, unit-based walkthrough intervention shown to be effective in reducing the risk of workplace violence in hospitals.Methods: A structured worksite walkthrough was conducted on 21 hospital units. Unit-level workplace violence data were reviewed and a checklist of possible prevention strategies and an Action Plan form guided development of unit-specific intervention. Unit supervisor perceptions of the walkthrough and implemented prevention strategies were reported via questionnaires. Prevention strategies were categorized as environmental, behavioral, or administrative.Results: A majority of units implemented strategies within 12 months' postintervention. Participants found the walkthrough useful, practical, and worthy of continued use.Conclusions: Structured worksite walkthroughs provide a feasible method for workplace violence reduction in hospitals. Core elements are standardized yet flexible, promoting fidelity and transferability of this intervention.
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