Jill Rierdan

Non-Physical Violence: A Risk Factor for Physical Violence in Health Care Settings

This research study assessed the extent to which non-physical violence is a risk factor for physical violence against workers in health care settings. More than 600 nursing staff, other clinical providers, and non-clinical staff in two health care settings completed a cross-sectional survey. For the preceding 12-month period, 72.8% of workers reported at least one incident of non-physical violence and 21.3% reported at least one incident of physical violence. Workers who had experienced non-physical violence were 7.17 times more likely to experience physical violence than those who had not. Both patients and employees were perpetrators of non-physical and physical violence. These results indicate efforts to prevent or reduce physical violence against health care workers need to focus on non-physical as well as physical violence and employee as well as patient perpetrators.

Symptoms of acute stress disorder and posttraumatic stress disorder following exposure to disastrous flooding

Abstract This lon gi tu di nal study ex am ined symp toms of acute stress dis or der (ASD) and posttraumatic stress dis or der (PTSD) fol low ing ex po sure to threat and loss dur ing a ma jor flood. One hun dred and thirtyone per sons com pleted an ini tial sur vey from one to three months postflood as sess ing ASD symp toms and ex po sure to floodre lated threat and losses; 74 of these per sons com pleted a one-year fol low-up as sessing PTSD symp toms. Re sults showed that threat and loss were both sig nif i cantly re lated to ASD symp toms. Ex po sure to losses and ASD symp toms, but not threat, pre dicted the de vel op ment of PTSD symp toms. These re sults sug gest that stressor char ac ter is tics, such as loss and threat, may be dif fer en tially re lated to shorter and lon gerterm trauma responses. These re sults ex tend pre vi ous re search by show ing that ASD symp toms pre dict those of PTSD among di sas ter sur vi vors and that stressor char ac ter is tics to gether with acute symp toms pre dict longterm dis tress.

Reducing Violence Against Nurses: The Violence Prevention Community Meeting

Research was undertaken to validate the efficacy of a new, nurse-led treatment, the Violence Prevention Community Meeting (VPCM), for reducing patient violence on an acute-care inpatient psychiatry unit. Nursing staff members carried event counters and recorded verbal and physical violence as it occurred over the 20-week study. Significant decreases in patient violence were found across day, evening, and night shifts for pre-treatment vs. treatment and pre-treatment vs. post-treatment comparisons. For the day shift, when twice-weekly VPCM treatment took place, violent incidents decreased 89% from pre-treatment to treatment and 57% from pre-treatment to post-treatment.

Incidence and risk factors of workplace violence on psychiatric staff

BACKGROUND A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. OBJECTIVE An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. PARTICIPANTS Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. METHODS Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. RESULTS Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm - 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am - 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. CONCLUSION Healthcare workers in psychiatric settings are at high risk for aggression from patients.

Multiple Perspectives on Assault: The 360-Degree Interview

Workplace violence is common in health care settings. The authors review various models of this violence that have developed over time. From a linear model, understanding progressed to an interactional and then to a contextual model of assault that examines interactions of the aggressor, victim, and the environment. To date, there has not been a satisfactory research methodology to explore the complexities of the contextual model. This article proposes the 360-degree evaluation as an appropriate methodology for examination of multiple perspectives on assault. The 360-degree model allows comparison of perspectives of the assailant, victim, victims peers, and victims supervisor. J Am Psychiatr Nurses Assoc, 2009; 14(6), 413-420.

Post-Traumatic Stress Disorder in Adults with Serious Mental Illness and Substance Abuse

ABSTRACT Post-Traumatic Stress Disorder continues to be under-diagnosed among individuals with severe mental illness and substance abuse. In a convenience sample of 64 patients with severe mental disorders being treated at an urban outpatient clinic, 24% met full criteria for PTSD based upon a comprehensive assessment protocol while only 3% were diagnosed with PTSD by clinicians in the medical record (Cochrans Q = 11.267, df 1, p <.001). In contrast, there was a high rate of diagnostic agreement for psychotic and affective illnesses as well as substance abuse. More attention needs to be given to systematically assessing PTSD among severely mentally ill and dually diagnosed individuals because even highly skilled diagnosticians miss the complex presentation of symptoms with which these patients present for treatment.

The Violence Prevention Community Meeting: A Multi-Site Study

OBJECTIVE The Violence Prevention Community Meeting (VPCM) is a specialized form of community meeting in which avoiding violence and promoting non-violent problem solving and interpersonal civility are focal points. A nationwide study to assess the VPCM as an effective intervention to reduce workplace violence was undertaken. PARTICIPANTS Seven acute locked psychiatric units of the Veterans Health Administration (VHA) throughout the United States participated in the study. METHODS All patients and all staff on the seven in-patient locked psychiatry units participated in the intervention (VPCM) or as a control (treatment as usual). The study was 21weeks at each site. The three time periods were pre-treatment weeks 1-3, treatment weeks 4-18, and post-treatment weeks 19-21. The VPCM was conducted during the treatment weeks. RESULTS Overall rates of aggression declined by 0.6% (95% CI: -5.6%, 6.5%; nonsignificant) per week in the intervention hospitals and by 5.1% (95% CI: 0.4%, 9.6%; significant) per week for the control hospitals. CONCLUSIONS Aggression decreased for both the intervention and control hospitals which could be due to enrollment in a research study and thus being more aware of their ability to address workplace violence at their site.