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BeckyMitchell-Vaughn,DNP,FNP-BC,ARNP
PREVENTINGVIOLENCEINTHEHOMEHEALTHCAREWORKPLACE
ENVIRONMENT
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“Serving the community is the essence of home care. Being a victim to the
environment is not”
Sylvester & Reisener, 2002, p. 71
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WHATCONSTITUTESWORKPLACEVIOLENCE?
• PhysicalViolence• PsychologicalViolence• VerbalAbuse• Intimidation• Bullying• SexualHarassment• RacialHarassment
OccupationalSafetyandHealthAdministration(2004)
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VIOLENCEINTHEHOMEHEALTHCAREENVIRONMENT
InternalFactors:• ViolentorUnstablePatientsorFamilyMembers
• IllicitDrugUse• Weaponspresentinthehome• DomesticViolence• Presenceofaggressiveanimals
ExternalFactors• Unsafeneighborhoodsorcommunities
• Gangorgangrelatedactivities• Robbery• CarTheft• Vandalism
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IN2009HOMEHEALTHNURSINGWASTHESECONDMOSTDANGEROUSOCCUPATIONINTHEUNITEDSTATESIN,FIRSTBEINGLAWENFORCEMENTPROFESSIONALS(UNITEDSTATESCRIMESTATISTICS,2010).
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Homehealthcareprovidershavebeenassaulted,robbed,raped,andevenmurderedwhileperformingtheirjobs.
•Therearenonationalguidelineswhichrequiretheworkplaceviolencetrainingofhomehealthcare(HHC)providers(Langetal.,2008).
•Therearenonationalstandards regulatingtheenvironmentinwhichhomehealthcareservicesarerendered(Langetal.,2008).
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Approximately66% ofviolentactsoccurredinthehealthcareandsocial
assistanceindustryworkplace(BureauofLaborandStatistics,2016).
In2015,homicidewasthesecondleadingcauseofdeathinhome
healthcareproviders,exceededonlybymotorvehiclesaccidents
(Phillips,2016).
Homehealthcareprovidersworkwithout thebenefitofsecurity
measuresseenininstitutionalizedsettings
(Cantonetal.,2009;Fazzone etal.,2000;Gross,NIOSH,2015;Peek-Asa,Nocera,&Casteel,2013).
Homeheathcareprovidersreportedthatthequalityoftrainingtheyreceivedfromtheiremployerwasinadequate inrelationtothesituationstheyencountered
(Fazzone etal.,2000;Sylvester&Reisener,2002;Vladutiu etal.,2016).
Significance of the Problem
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Review of Literature• Violence occursinallhealthcaresettings,butHHCprovidersfaceauniquesetofrisksandchallenges.
• HHCprovidersareoftenplacedinenvironmentswheretheyworkunaccompanied,devoidoftheadvantageofcustomarysafetymeasuresthatarecommonintheacute-caresetting.
• Theinfluence thatworkplaceviolencecanhaveinhomehealthcareiswidespreadandpervasive,withitseffectsfeltfrequentlyinpatientcare.
• TheactualnumberofHHCproviderswhohavebeenaffected byworkplaceviolenceastheresultofprovidingpatientcareisnotactuallyknown,becausenursestendtotolerateverbalabuseandviolenceandtonotformallyreportit
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WHATTHELITERATUREISSAYING?
• Lackofhealthcareprofessionalsreportingviolence.• Inconsistentstandardsoftrainingacrosstheindustry• Needforworkplaceviolenceprevention/trainingprograms
• Impactsonthedeliveryofcareduetosafetyconcernsforhomehealthprofessionals
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IMPACTONDELIVERYOFHEALTHCAREEmployee• Physicalandpsychologicaleffectsonemployees• Poorjobsatisfactionandreducedemployeeretentionrate
Patient• Delayedorshortenedvisits• Unabletoobtaincareindangerousneighborhoods
HealthcareSystem• Increasedlengthofhospitalstay• Increasedcostinobtainingalternativecare
Canton et al., 2009; Fazzone, Barloon, McConnell, & Chitty, 2000
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LACKOFREPORTING
• “Partofthejob”• PeerPressure• AdministrativePressure• Senseofdutytopatient• Loyaltytopatient• Offsetbypatientneeds
Fazzone etal.,2000;Mathiews &Salmond,2013;McPhaul &Lipscomb,2004;Zolnlerek,2015
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INCONSISTENTTRAININGSTANDARDS• Employeesreportedtrainingtheyreceivedfromtheiremployer
wasinadequateinrelationtothesituationstheyencountered
• Californiamandatedtraininghoweveronly55percentofhomehealthcareagenciesactuallyhadformalprogramsinplaceandmanyofthemwerenorreviewedorupdatedonaregularbasis.
• Inotherstateswheretrainingwasnotmandatedthereseemedtobeadisconnectasseveralagenciesreportedthattheylackedpolicies,procedures,andwrittenstandardsformanagementofworkplaceviolencenordotheyprovidesafetytrainingfortheirstaff.
Fazzone et al., 2000; Gross et al., 2013; Mathiews & Salmond, 2013
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WORKPLACEVIOLENCEPREVENTIONTRAININGPROGRAMNEEDS• Definingtypesofviolenceforproviders
• Clarifyingwhatarethreateningbehaviors
• Reiteratingneedforproviderstoreportincidences• Identifyingriskfactorsforproviders
• Providingstrategiesonhowtorespondtothreateningsituations
NIOSH, 2015; Vladutiu et al., 2016
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WORKPLACEVIOLENCEPREVENTIONTRAININGPROGRAMNEEDS
• NoregulatoryrequirementormandatesoneitherStateofFederallevelforemployeestobetrainedforviolenceprevention. (Vladutiu et al., 2016)
• OSHAhasprovidedguidanceandhasexpressedthattheguidelinesthattheyhaveprovidedareneithernewstandardsnornewregulations,thattheyaremeanttobeadvisoryandinformational. (OSHA, 2015)
• In2015theNationalInstituteforOccupationalSafetyandHealth(NIOSH)developedandrecommendedtheimplementationofaworkplaceviolencetrainingprogramspecificallyforhomehealthcareprovidersaddressingsafetyinthehomeworkplaceenvironment. (NIOSH, 2015)
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THENATIONALINSTITUTEFOROCCUPATIONALSAFETYANDHEALTH
GUIDELINES
• Createazerotolerancepolicyforworkplaceviolence.
• Askemployeestoreporteachincident,eveniftheythinkit
won’thappenagainoritmightnotbeserious.
• Developawrittenplanforensuringpersonalsafety,
reportingviolence,andcallingthepolice.
• Conducttrainingontheworkplaceviolenceplanwhenthe
employeeishiredandannuallythereafter.
NIOSH, 2015
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• Letworkersknowabouttherisksoftheirassignmentsandhowtoassessthesafetyoftheirworkenvironmentanditssurroundings.
• Trainemployeestorecognizeverbalabuse.
• Trainemployeestoidentifydifferenttypesofillegaldrugsanddrugparaphernalia.
• Trainemployeestorecognizethesignsandbodylanguageassociatedwithviolentassaultandhowtomanageorpreventviolentbehavior,suchasverbalde-escalationtechniques,managementofangrypatients,recognizingandprotectingthemselvesfromgangsandgangbehavior
NIOSH, 2015
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RESEARCHQUESTION
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Inhomehealthcareproviders,howdoesaneducationalandtrainingprogramforworkplaceviolencepreventionaffectHHCproviders’perceivedabilitytoassessriskandpreventviolenceduringhomehealth
visits?
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METHODS
Design:Quasiexperimentalpre-postdesign
Sample:Convenience,N=98pretestandN=80posttest(unmatcheddata).Inclusioncriteriawerethatparticipantswere18yearsorolderandcurrentlyemployedasahomehealthcareprovider.Thosewhodidnotmeetthesecriteriawereexcluded.
Setting:PrivatelyownedhomehealthagencylocatedinCentralFlorida.
DataCollectionTool:Investigatorcreatedtheonlinesurveycomprisedofsixsectionsand31questionswhichwasvalidatedbyhomehealthcareindustryexperts.
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Procedures:HHCagencypersonnelwereinvitedtoparticipateinthisstudypriortoattendingasix-hourWorkplaceViolencePrevention(WVP)trainingprogramandtwoweeksafterthetrainingprogram.
DataCollection: DatawascollectedviaSurveyMonkey© andexportedintoaconfidentialexcelspreadsheetwithnoparticipantidentifiableinformation.
DataAnalysis:Chisquaredtestsanddescriptivestatisticswereutilized.DatawasanalyzedusingIBMSPSSStatisticsforWindows,(Version24.0.Armonk,NY:IBMCorp).
METHODSCONT.
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PROGRAMDELIVERYPROCESS
Pre-test Training Post-test
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PRE/POSTTESTQUESTIONSWhatisworkplaceviolence?Haveyoueverbeenprovidedwithaworkplaceviolencetrainingprogram?Haveyoueverencounteredworkplaceviolence?Haveyoureportedworkplaceviolence?Haveyoueverfeltunsafeinaworkplaceenvironment?Howlonghaveyouworkedasahealthcareprofessional?
Whatisyouworkexperience?
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CRISISPREVENTIONINSTITUTE(CPI)
TRAININGPROGRAM
• Comprehensive6-hourbehaviormanagementprogram
• Competency-based,practiceanddemonstrateknowledgeofverbalandphysicalinterventiontechniques
• Focus:Preventionandinterveningearly
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RESULTS
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RESULTS
Table1.PreandPostTrainingComparisonofTypeofWVPEducationandTrainingReceivedbyProvider
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PreandPostTrainingComparisonofProviderComfortinHandlingAggressiveSituations
Results
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Pre and Post Training Comparison of Provider Awareness of Possible Safety Risks
RESULTS
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WVPeducationandtrainingforHHCprovidersresultedinsignificantincreases in:
• awarenessofpotentialsafetyrisks,• reports ofexposuretosafetyrisk,• comfortlevelsinhandlingaggressivepatientsandfamilymembers.
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“Allemployershaveageneraldutytoprovidetheiremployeeswithaworkplacefreefromrecognizedhazardslikelytocausedeathorseriousharm”
OSHA, 2004
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HHCagencieshaveanobligationtoprovideacomprehensiveWVPeducationandtrainingprogramstoemployees.
Providersneedtoconsistentlyreportinstancesofworkplaceviolence.
FurtherstudiesareneededtoevaluatetheimpactthataWVPeducationandtrainingprogramhasonproviderpractice.
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LIMITATIONS
Theuseofanon-randomconveniencesampleincreasestheprobabilityofresponsebias.
Thesamplesizewassmallandconfinedtooneagencylocationinonegeographiclocation.
Administrationofpre-testmayhaveinfluenceonparticipants'knowledgeirrespectiveofthetrainingprogram.
Utilizingaself-reportquestionnairemayresultinresponsebias.
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RECOMMENDATIONSFORFUTUREPRACTICE
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NURSINGPRACTICE
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EDUCATION
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RESEARCH
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POLICY
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INITIALTRAININGREQUIREDANNUALTRAININGREQUIREDANNUALSURVEYS
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References
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Gross, N., Peek-Asa, C., Nocera, M., & Casteel, C. (2013). Workplace violence prevention policies in home health and hospice care agencies. Online Journal of Issues In Nursing, 18.
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Via Browning, S., Culver Clark, R., & Glick, R. E. (2013). Preparing for the unexpected. Home Healthcare Nurse, 31(6), 303-309. http://dx.doi.org/10.1097/NHH0b013e318291ee9c
Vladutiu, C., Casteel, C., Nocera, M., Harrison, R., & Peek-Asa, C. (2016). Characteristics of workplace violence prevention training and violent events among home health and hospice care providers. American Journal Of
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Workplace violence prevention for nurses. (2015). Retrieved June 3, 2016, from https://www.cdc.gov/niosh/topics/healthcare/