Helen Hansen

An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study

Aims: To identify the magnitude of and potential risk factors for violence within a major occupational population. Methods: Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility. Results: From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients. Conclusions: Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital.

BACKGROUND Birth trauma is a low-frequency, high-severity event, making obstetrics a major challenge for patient safety. Yet, few strategies have been shown to eliminate preventable perinatal harm. Interdisciplinary team training was prospectively evaluated to assess the relative impact of two different learning modalities to improve nontechnical skills (NTS)--the cognitive and interpersonal skills, such as communication and teamwork, that supplement clinical and technical skills and are necessary to ensure safe patient care. METHODS Between 2005 and 2008, perinatal morbidity and mortality data were prospectively collected using the Weighted Adverse Outcomes Score (WAOS) and a culture of safety survey (Safety Attitudes Questionnaire) at three small-sized community hospitals. In a small cluster randomized clinical trial conducted in the third quarter of 2007, one of the hospitals served as a control group and two served as the treatment intervention sites--one hospital received the TeamSTEPPS didactic training program and one hospital received both the TeamSTEPPS program along with a series of in-situ simulation training exercises. RESULTS A statistically significant and persistent improvement of 37% in perinatal morbidity was observed between the pre- and postintervention for the hospital exposed to the simulation program. There were no statistically significant differences in the didactic-only or the control hospitals. Baseline perceptions of culture of safety were high at all three hospitals, and there were no significant changes. CONCLUSIONS A comprehensive interdisciplinary team training program using in-situ simulation can improve perinatal safety in the hospital setting. This is the first evidence providing a clear association between simulation training and improved patient outcomes. Didactics alone were not effective in improving perinatal outcomes.

In situ simulation: a method of experiential learning to promote safety and team behavior.

The healthcare system has an inconsistent record of ensuring patient safety. One of the main factors contributing to this poor record is inadequate interdisciplinary team behavior. This article describes in situ simulation and its 4 components-–briefing, simulation, debriefing, and follow-up—as an effective interdisciplinary team training strategy to improve perinatal safety. The purpose of this manuscript is to describe the experiential nature of in situ simulation for the participants. Involved in a pilot study of 35 simulations in 6 hospitals with over 700 participants called, “In Situ Simulation for Obstetric and Neonatal Emergencies,” conducted by Fairview Health Services in collaboration with the University of Minnesotas Academic Health Center.

Risk factors for work-related assaults on nurses

Background: Work-related homicides have been the subject of considerable study, but little is known about nonfatal violence and relevant risk factors. Methods: We surveyed 6300 Minnesota nurses who were selected randomly from the 1998 licensing database and determined their employment and occupational violence experience. In a nested case–control study, we examined environmental exposures and physical assault. Cases of assault in the previous 12 months and controls randomly selected from assault-free months were surveyed about prior-month exposures. Results: After adjustment by multiple logistic regression, incidence of physical assault was 13.2 per 100 persons per year (95% confidence interval = 12.2–14.3). Among 310 cases and 946 control subjects, odds ratios for assault were increased: in nursing homes or long-term care facilities (2.6; 1.9–3.6), emergency departments (4.2; 1.3–12.8), and psychiatric departments (2.0; 1.1–3.7); in environments not “bright as daylight” (2.2; 1.6–2.8); and for each additional hour of shift duration (1.05; 0.99–1.11). Risks were decreased when carrying cellular telephones or personal alarms (0.3; 0.2–0.7). Conclusions: These results may guide in-depth investigation of ways protective and risk factors can control violence against nurses.

Predictors of elder and family caregiver satisfaction with discharge planning.

Client satisfaction is considered an important outcome measure in a managed care environment faced with escalating health care costs, shortened lengths of hospital stay, and competition among acute care hospitals. With shortened lengths of stay in acute care hospitals, discharge planning has assumed increased importance, particularly for elders who have chronic conditions, such as heart failure, that require follow-up care. Consequently, understanding the predictors of client satisfaction with discharge planning can help hospitals and their nursing staff to tailor services to meet client needs. Previous studies have focused on patient satisfaction with hospital care, with little attention given specifically to satisfaction with discharge planning and to family caregiver satisfaction with discharge planning. The purpose of this study was to determine whether there is a difference between elder and family member satisfaction with discharge planning 2 weeks after hospitalization and what factors predict satisfaction with discharge planning 2 weeks after hospitalization for elders hospitalized with heart failure and their family caregivers. Telephone interviews were conducted with 134 elder/family caregiver dyads 2 weeks after hospitalization. The results indicated that there were no statistically significant differences in discharge planning satisfaction of elders and their family caregivers. Continuity of care and extent to which they felt prepared to manage care following hospitalization were the best predictors of elders and family caregivers satisfaction with discharge planning.

Differences in family caregiver outcomes by their level of involvement in discharge planning

Family caregivers play vital roles in assisting elders after they are released from the hospital. Although health care professionals advocate involving family caregivers in discharge planning for elders, little is known about the extent to which this involvement benefits or jeopardizes the caregivers health and their perceptions of the caregiving experience. The purpose of this study was to determine whether the level of family caregiver involvement in discharge planning for an elder made a difference in caregiver health, discharge planning satisfaction, perception of care continuity, preparedness to assist the elder, and acceptance of the caregiving role 2 weeks and 2 months postdischarge. The sample consisted of 130 family caregivers for elders hospitalized with heart failure. Telephone interviews were conducted 2 weeks and 2 months postdischarge. The findings indicated that family caregivers who reported more involvement in discharge planning had significantly higher scores on satisfaction, feelings of preparedness, and perception of care continuity 2 weeks following the elders hospitalization than those who reported little or no involvement in planning. Caregivers who reported more involvement in planning also were more accepting of the caregiving role. At 2 months postdischarge, caregivers who reported more involvement in discharge planning reported better health and more acceptance of the caregiving role than those who had little or no involvement in planning.

Detecting breaches in defensive barriers using in situ simulation for obstetric emergencies

Background In Reasons safety model, high-reliability healthcare organisations are characterised by multiple layers of defensive barriers in depth associated with increased levels of safety in the care delivery system. However, there is very little empirical evidence describing and defining defensive barriers in healthcare settings or systematic analysis documenting the nature of breaches in these barriers. This study uses in situ simulation to identify defensive barriers and classify the nature of active and latent breaches in these barriers. Methods An in situ simulation methodology was used to study team performance during obstetrics emergencies. The authors conducted 46 trials of in situ simulated obstetrics emergencies in two phases at six different hospitals involving 823 physicians, nurses and support staff from January 2006 to February 2008. These six hospitals included a university teaching hospital, two suburban community hospitals and three rural hospitals. The authors created a high-fidelity simulation by developing scenarios based on actual sentinel events. Results A total of 965 breaches were identified by participants in 46 simulation trials. Of the 965 breaches, 461 (47.8%) were classified as latent conditions, and 494 (51.2%) were classified as active failures. Conclusions In Reasons model, all sentinel events involve a breached protective layer. Understanding how protective layers breakdown is the first step to ensure patient safety and establish a high reliability. These findings suggest where to invest resources to help achieve a high reliability. In situ simulation helps recognise and remedy both active failures and latent conditions before they combine to cause bad outcomes.

Relation between policies and work related assault: Minnesota Nurses’ Study

Aims: To assess the relation between violence prevention policies and work related assault. Methods: From Phase 1 of the Minnesota Nurses’ Study, a population based survey of 6300 Minnesota nurses (response 79%), 13.2% reported experiencing work related physical assault in the past year. In Phase 2, a case-control study, 1900 nurses (response 75%) were questioned about exposures relevant to violence, including eight work related violence prevention policy items. A comprehensive causal model served as a basis for survey design, analyses, and interpretation. Sensitivity analyses were conducted for potential exposure misclassification and the presence of an unmeasured confounder. Results: Results of multiple regression analyses, controlling for appropriate factors, indicated that the odds of physical assault decreased for having a zero tolerance policy (OR = 0.5, 95% CI 0.4 to 0.8) and having policies regarding types of prohibited violent behaviours (OR = 0.5, 95% CI 0.3 to 0.9). Analyses adjusted for non-response and non-selection resulted in wider confidence intervals, but no substantial change in effect estimates. Conclusions: It appears that some work related violence policies may be protective for the population of Minnesota nurses.

Interdisciplinary collaboration and discharge planning communication for elders

The effects of personal characteristics and perceptions of interdisciplinary collaboration on discharge planning communication were examined for nurses, physicians, and social workers in two hospitals. The model for the study explained 61.7% of the variance in discharge planning communication for nurses. For all 142 health professionals, communication openness with social workers, problem solving between nurses and physicians, and collaboration with social workers were important to discharge planning communication. For nurses, communication satisfaction with patients and families also was important.

A model for collegiality among staff nurses in acute care.

For decades, collegiality has persisted as an important issue for nurses, especially for nurse leaders. In an increasingly interdependent healthcare environment, collegial relationships among nurses and other health professionals are vital to achieving the goal of clinically integrated care. Nurse administrators greatly influence decision making among health professionals by monitoring and facilitating their interactions. The model used in this study contributes to an understanding of the factors that affect collegiality among nurses and potentially among other members of the healthcare team.