Donna M. Gates

Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity

Objective: To examine whether obesity is associated with increased presenteeism (health-related limitations at work). Methods: Randomly selected manufacturing employees (n = 341) were assessed via height and weight measures, demographic survey, wage data, and the Work Limitations Questionnaire. The Work Limitations Questionnaire measures productivity on four dimensions. Analyses of variance and analyses of covariance were computed to identify productivity differences based on body mass index (BMI). Results: Moderately or extremely obese workers (BMI ≥35) experienced the greatest health-related work limitations, specifically regarding time needed to complete tasks and ability to perform physical job demands. These workers experienced a 4.2% health-related loss in productivity, 1.18% more than all other employees, which equates to an additional

Violence against caregivers in nursing homes. Expected, tolerated, and accepted

506 annually in lost productivity per worker. Conclusions: The relationship between BMI and presenteeism is characterized by a threshold effect, where extremely or moderately obese workers are significantly less productive than mildly obese workers.

Relationships of Stressors, Strain, and Anger to Caregiver Assaults

Violence against caregivers is not a new phenomenon. Caregivers have experienced verbal and physical assaults from nursing home residents for many years. However, because much of the violence has been associated with demented or mentally ill residents, the word aggression was used in lieu of violence. This study found that the caregivers and nursing directors considered the assaults to be violence. The study suggests that such violence occurs frequently and is of concern to caregivers and nursing directors. The study also suggests that nursing homes may not have policies or procedures in place for preventing, monitoring, and controlling violence in their workplaces. In 1996, OSHA published violence prevention guidelines for health are facilities. These guidelines support OSHAs mandate that employees are entitled to a safe and healthy workplace (OSHA, 1996b). Although it is not possible to prevent all violence against caregivers in this unique setting, nursing home directors and administrators have a legal and moral responsibility to develop an action plan to minimize the violence and plan interventions for its effects. Violence against caregivers in nursing homes no longer can be thought of as expected, tolerated, and accepted. Quality of care and employee well-being depend on it.

Workplace Violence in Healthcare Settings: Risk Factors and Protective Strategies

Nursing assistants (NAs) working in nursing homes are at risk for nonfatal workplace violence. The aims of this study were to describe the context in which assaults occur and to identify characteristics of the NAs related to the incidence of assaults. One hundred and thirty eight subjects participated. NAs completed a demographic and employment survey, the Occupational Stress Inventory and the State Trait Anger Expression Inventory-2, and recorded information on an Assault Log for 80 hours of work. The mean number of assaults per NA was 4.69 (range 0-67). Significant relationships were found among incidence of assaults and staffing ratios, age, occupational strain, occupational role stressors, and anger. Results provide new and useful information when planning violence prevention programs for caregivers in nursing homes.

Workplace Violence in Emergency Medicine: Current Knowledge and Future Directions

&NA; This article describes the risk factors and protective strategies associated with workplace violence perpetrated by patients and visitors against healthcare workers. Perpetrator risk factors for patients and visitors in healthcare settings include mental health disorders, drug or alcohol use, inability to deal with situational crises, possession of weapons, and being a victim of violence. Worker risk factors are gender, age, years of experience, hours worked, marital status, and previous workplace violence training. Setting and environmental risk factors for experiencing workplace violence include time of day and presence of security cameras. Protective strategies for combating the negative consequences of workplace violence include carrying a telephone, practicing self‐defense, instructing perpetrators to stop being violent, self‐ and social support, and limiting interactions with potential or known perpetrators of violence. Workplace violence is a serious and growing problem that affects all healthcare professionals. Strategies are needed to prevent workplace violence and manage the negative consequences experienced by healthcare workers following violent events.

Reducing assaults against nursing home caregivers

BACKGROUND Workplace violence (WPV) has increasingly become commonplace in the United States (US), and particularly in the health care setting. Assaults are the third leading cause of occupational injury-related deaths for all US workers. Among all health care settings, Emergency Departments (EDs) have been identified specifically as high-risk settings for WPV. OBJECTIVE This article reviews recent epidemiology and research on ED WPV and prevention; discusses practical actions and resources that ED providers and management can utilize to reduce WPV in their ED; and identifies areas for future research. A list of resources for the prevention of WPV is also provided. DISCUSSION ED staff faces substantially elevated risks of physical assaults compared to other health care settings. As with other forms of violence including elder abuse, child abuse, and domestic violence, WPV in the ED is a preventable public health problem that needs urgent and comprehensive attention. ED clinicians and ED leadership can: 1) obtain hospital commitment to reduce ED WPV; 2) obtain a work-site-specific analysis of their ED; 3) employ site-specific violence prevention interventions at the individual and institutional level; and 4) advocate for policies and programs that reduce risk for ED WPV. CONCLUSION Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

Using Action Research to Plan a Violence Prevention Program for Emergency Departments

BackgroundNursing assistants (NAs) working in long-term care have the highest incidence of workplace assault among all workers in the United States. ObjectivesThe objective of this study was to test the effectiveness of a violence-prevention intervention, on the basis of Social Cognitive Theory to increase knowledge, self-efficacy, and skills, and to decrease assaults. MethodsInvestigators conducted a quasi-experimental study with 138 NAs in 3 intervention and 3 comparison homes. A baseline questionnaire was used to obtain information on demographics, employment, and violence experience. At pre-, post- and 6 months after the intervention, all participants completed the State Trait Anger Inventory and the Knowledge and Self-Efficacy Survey, carried an Assault log for 80 hr of work, and participated in a simulation exercise to assess violence-prevention skills. Tabulations, analysis of variance, and Poisson regression were used to analyze the data. ResultsThe intervention participants showed significant increases in knowledge, self-efficacy, and violence-prevention skills. Although the intervention had no significant main effect on the incidence of assaults, there was an interaction effect between the intervention and the number of preintervention assaults. The intervention had a significant effect on those NAs who had fewer than 6 assaults preintervention (p < .001) and no significant effect on those who had more than 7 assaults on preintervention. There were significant relationships between assaults and the following covariates: age, state anger, and the number of residents assigned. DiscussionAlthough the incidence of violence cannot be eliminated, it can be decreased and it should never be tolerated or accepted as “part of the job” because to do so devalues the NA.

Secondary traumatic stress in nurses who care for traumatized women.

INTRODUCTION Although there are numerous studies that show that emergency department (ED) violence is a prevalent and serious problem for healthcare workers, there is a lack of published evaluations of interventions aimed at reducing this alarming trend. Using an action research model, the authors partnered with six hospitals to plan, implement and evaluate a violence prevention and management intervention. Phase one of this project involved gathering information from employees, managers and patients using focus groups. METHODS Ninety-seven persons participated in one of twelve focus groups. The Haddon matrix was used to develop focus group questions aimed at gathering data about the pre-assault, during assault, and post-assault time frames and to compare these findings to planned strategies. Analysis consisted of identification of themes related to intervention strategies for patients/visitors, employees, managers, and the work environment. RESULTS Thematic analysis results supported the relevance, feasibility, and saliency of the planned intervention strategies. With the exception of a few items, employees and managers from the different occupational groups agreed on the interventions needed to prevent and manage violence against ED workers. Patients focused on improved staff communication and comfort measures. DISCUSSION Results support that violence in the emergency department is increasing, that violence is a major concern for those who work in and visit emergency departments, and that interventions are needed to reduce workplace violence. The Haddon matrix along with an action research method was useful to identify intervention strategies most likely to be successfully implemented and sustained by the emergency departments.

Posttraumatic Stress Symptomatology among Emergency Department Workers following Workplace Aggression

Each year, thousands of women experience violence, and many of these are survivors of intimate partner violence. Each year, thousands of nurses provide physical and emotional care to these women. Nurses and employers need to recognize that exposures to traumatized women place nurses at risk for the development of secondary traumatic stress disorder. This article describes secondary traumatic stress, its risk factors, and its consequences. Workplace interventions and policies are recommended to reduce the avoidance, numbness, intrusive imagery, and other negative symptoms associated with secondary traumatic stress disorder.

Occupational and demographic factors associated with violence in the emergency department

Workplace aggression has the potential to adversely affect the psychological health of emergency department (ED) workers. The purpose of this study was to compare posttraumatic stress symptomatology based on verbal and verbal plus physical aggression. A descriptive cross-sectional design was used with a convenience sample (n = 208) of ED workers who completed a three-component survey. Descriptive statistics were computed to compare traumatic stress scores based on type of aggression. Two-way analysis of variance statistics were computed to determine if scores differed on the demographic variables. Fewer than half of the ED workers reported traumatic stress symptomatology; however, workplace aggression has the potential to adversely affect the mental health of ED workers. Occupational health nurses can establish or maintain a nurturing and protective environment open to discussing the personal thoughts, feelings, and behaviors of ED workers related to their experiences of workplace aggression. This open and more positive work environment may aid in reducing the negative impact of posttraumatic stress symptoms among those ED workers who have been victimized.