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Older adults may suddenly exhibit behaviors that are viewed as noncompliant, noncooperative, and threatening. They may even lash out verbally and physically causing injury to health care staff. In addition to taking actions that prevent harm to the staff and the patient, determining what caused this behavior (dementia vs delirium or other cases) will be critical, as well as debriefing the staff after the incident.

Background Consumer-driven homecare models support aging and disabled individuals to live independently through the services of homecare workers. Although these models have benefits, including autonomy and control over services, little evidence exists about challenges homecare workers may face when providing services, including workplace violence and the negative outcomes associated with workplace violence. This study investigates the prevalence of workplace violence among homecare workers and examines the relationship between these experiences and homecare worker stress, burnout, depression, and sleep. Methods We recruited female homecare workers in Oregon, the first US state to implement a consumer driven homecare model, to complete an on-line or telephone survey with peer interviewers. The survey asked about demographics and included measures to assess workplace violence, fear, stress, burnout, depression and sleep problems. Results Homecare workers (n = 1,214) reported past-year incidents of verbal aggression (50.3% of respondents), workplace aggression (26.9%), workplace violence (23.6%), sexual harassment (25.7%), and sexual aggression (12.8%). Exposure was associated with greater stress (p < .001), depression (p < .001), sleep problems (p < .001), and burnout (p < .001). Confidence in addressing workplace aggression buffered homecare workers against negative work and health outcomes. Conclusions To ensure homecare worker safety and positive health outcomes in the provision of services, it is critical to develop and implement preventive safety training programs with policies and procedures that support homecare workers who experience harassment and violence.

Research to date has largely been unclear about whether a single perpetrator is sufficient to instigate the well-documented negative consequences of workplace incivility. In the current research, we examine the extent to which perceived belongingness and embarrassment mediate the relationship between incivility from a single perpetrator and two important outcomes (job insecurity and somatic symptoms), and the extent to which the perpetrator’s power moderates these relationships. Across two studies using different methods, we find that incidents of single perpetrator incivility are associated with target feelings of isolation and embarrassment, which in turn relate to targets’ perceived job insecurity and somatic symptoms (Studies 1 and 2) both the same day and three days later (Study 2). Moreover, we find that perpetrator power moderates the relationship between incivility and embarrassment, such that targets are more embarrassed when the perpetrator is powerful. Implications for theory and practice are discussed.

Workplace violence (WPV) has been extensively studied in hospitals, yet little is known about WPV in outpatient physician clinics. These settings and work tasks may present different risk factors for WPV compared to hospitals, including the handling/exchange of cash, and being remotely located without security presence. We conducted a systematic literature review to describe what is currently known about WPV in outpatient physician clinics. Six literature databases were searched and reference lists from included articles published from 2000–2019. Thirteen quantitative and five qualitative manuscripts were included which all focused on patient/family-perpetrated violence in outpatient physician clinics. No studies examined other violence types (e.g., worker-on-worker; burglary). The overall prevalence of Type II violence ranged from 9.5% to 74.6%, with the most common form being verbal abuse (42.1–94.3%), followed by threat of assault (14.0–57.4%), bullying (2.5–5.7%), physical assault, (0.5–15.9%) and sexual harassment/assault (0.2–9.3%). Worker consequences included reduced work performance, anger, and depression. Most workers did not receive training on how to manage a violent patient. More work is needed to examine the prevalence and risk factors of WPV in outpatient physician clinics for purposes of informing prevention efforts in these settings.

Workplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses. A mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups. Ninety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups. Nurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.

Workplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency. Following staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared. Incidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints. The Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.

The present article takes an integrative perspective on the field of workplace aggression to highlight areas of ambiguity and opportunities for future research. First, by simultaneously examining the perpetrator- and target-focused literatures, we identify a great deal of overlap between predictors and outcomes in the two literatures, giving rise to the question of whether key constructs are predictors, outcomes, or both. Second, we determine that the question of \"who is the perpetrator?\" and \"who is the target?\" is considerably more ambiguous than implied within each of these independent literatures. Third, our examination suggests that a greater focus on the relational aspect of workplace aggression is particularly important to enable a more comprehensive understanding of this phenomenon. We examine and critique current methods and measurement and propose different approaches to explore workplace aggression in a more dynamic and contextualized way.

Introduction Staff working at inpatient psychiatric hospitals are at greater risk of being exposed to workplace aggression, with an incidence rate over 32% worldwide. Workplace aggression includes behaviours or actions that are meant to inflict harm or injury, verbally or physically, to another person. Exposure to aggressive behaviour is associated with negative work-related outcomes and higher levels of coercive measures in mental health care facilities. Several interventions aimed to prevent or reduce workplace violence have been developed, and staff training programs have shown to have some efficacy towards increasing staff knowledge and competence, in addition to reduce coercion to patients. “Management of Aggression Program (MAP)” is a Norwegian, nationally employed staff training program designed after classic triage from green to red, and is categorized as primary-, secondary- and tertiary prevention, with the aim to providing staff basic understanding of aggression, risk assessment, violence prevention, preventive communication, de-escalation, teamwork and self-regulation. This pilot study aims to explore the possible mediating mechanisms of MAP. Methods A qualitative exploratory study design was used. Data was collected by repeated semi-structured interviews of four participants at two different timepoints, using thematic analysis to analyse the written transcripts. Findings and conclusions The findings of this study suggest that themes within domain of cognitive reframing and contextualization might be the most important mediating mechanisms of the staff training program. The interviewed participants found the training program to be engaging, and the training provided the participants with knowledge and skills to be confident and conscious of their work. There is a lack of prior research or published studies about MAP, and similar programs, as of writing this report. Therefore, a need for further research on this topic is necessary. The findings of this study might be suitable for selection and operationalization of endpoints in future studies.

The interest generated by abusive supervision among researchers can be gauged from the fact that more than 140 articles on abusive supervision have been published by leading journals in the last five years alone. However, a comprehensive understanding of the same is lacking. As a result, we systematically reviewed 273 articles on abusive supervision published between 2000 and 2022. This enabled us to present five interrelated aspects of abusive supervision literature. First, we focus on the definitional issues associated with abusive supervision. Second, we examine two widely used abusive supervision scales. Third, we review and critique different research designs utilized in abusive supervision studies. Fourth, we look at the key theories underpinning abusive supervision research and map the nomological network of abusive supervision. Fifth, we suggest novel avenues for theoretical advancement. In sum, we endeavored to portray a detailed picture of research on abusive supervision.

Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so. CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken. Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area. There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted. [Display omitted]