Judith E. Arnetz

Violence toward health care workers. Prevalence and incidence at a large, regional hospital in Sweden

The aim of this study was to establish data for career prevalence and 1 year incidence of workplace violence for major categories of health care workers. Three consecutive work environment questionnaire studies at a large Swedish hospital provided the basis for the study. Prevalence and incidence rates of violence were age and gender adjusted to the Swedish working population. Prevalence of violence in the study population was compared to data from a national sample of Swedish registered nurses. Incidence of violence in each professional group was compared to that of the largest group of hospital employees, registered nurses. Standardized prevalence ratios for violence were significantly higher for all nursing personnel and physicians, and were highest for practical nurses (1.56). Standardized incidence rates ranged from 18/100 person years for physicians to 31/100 person years for practical nurses. The relative risk for violence at work over a 1 year period was significantly higher only for practical nurses (1.59) as compared to registered nurses. Nursing personnel and physicians were at considerable risk for workplace violence in the course of their careers. One year incidence rates were highest for practical nurses.

Organizational climate, occupational stress, and employee mental health: mediating effects of organizational efficiency.

Objective: To determine whether the relationship between organizational climate and employee mental health is consistent (ie, invariant) or differs across four large hospitals, and whether organizational efficiency mediates this relationship. Methods: Participants (total N = 5316) completed validated measures of organizational climate variables (social climate, participatory management, goal clarity, and performance feedback), organizational efficiency, occupational stress, and mental health. Results: Path analysis best supported a model in which organizational efficiency partially mediated relationships between organizational climate, occupational stress, and mental health. Conclusions: Focusing on improving both the psychosocial work environment and organizational efficiency might contribute to decreased employee stress, improved mental well-being, and organizational performance.

Patient participation during hospitalization for myocardial infarction: Perceptions among patients and personnel

BACKGROUND Patient participation in healthcare decision-making and illness management has been associated with high patient satisfaction ratings and improved treatment outcomes in chronic diseases. Less is known about patient participation in acute illness, such as myocardial infarction (MI). AIM To explore and describe patient and personnel perceptions of patient participation in care processes and decision-making during hospitalization for MI. METHOD A descriptive qualitative design was used. Five thematic focus group interviews were carried out (n = 25), two with patients and three with personnel, at three Swedish hospitals in 2005. Two researchers were present during the interviews; one as facilitator and one responsible for documentation. The interviews were recorded, transcribed verbatim and analysed through a thematic stepwise method. RESULTS Five themes emerged from the interviews: the meaning of patient participation, positive outcomes, difficult situations, hindrances and facilitating factors. A shared basic assumption in all groups was that patient participation is valuable and desirable in the patient-doctor/nurse encounter in MI care. However, both staff and patients viewed patient participation primarily as information. Active involvement in medical decision-making was less emphasized. Participation was judged as especially difficult to achieve during the initial, emergency phase of MI, although the informants also stressed the need for information in this phase. Positive outcomes of patient participation mentioned were that the patient may feel more secure if involved and that he/she might be more committed to the recovery process. Hindrances were lack of time, staff and, in patients, medical knowledge. Patient characteristics could also influence the level of participation. CONCLUSION If patient participation is to be achieved in all phases of MI care, patients need to be made aware of their right to participate. Health care professionals need to develop appropriate communication skills for each phase of the MI patients hospitalization.

Resilience as a Protective Factor against the Development of Psychopathology among Refugees

Abstract Refugee research, to date, has predominantly focused on factors that make refugees more vulnerable for developing posttraumatic stress disorder (PTSD) and/or psychological distress. Few articles have studied potential protective factors such as resilience. A targeted nonrandom sample of Iraqi refugees (n = 75) and a control group of non-Iraqi Arab immigrants (n = 53) were recruited from a number of Iraqi/Arab community institutions in Michigan to complete a questionnaire that included measures for psychological distress, PTSD symptoms, exposure to trauma, and resilience. The refugees reported significantly more PTSD symptoms (t-test, p < 0.01) and psychological distress (p < 0.05) compared with the immigrants. There was no difference in resilience between the two groups. In linear regression, premigration exposure to violence was a significant predictor of psychological distress (p < 0.01) and PTSD symptoms (p < 0.01). After controlling for migrant status and violence exposure, resilience was a significant inverse predictor of psychological distress (p < 0.001) but not of PTSD. Resilience is associated with less trauma-related psychological distress and should be considered in assessing risk and protective factors among victims of war-related violence.

Sociodemographic risk indicators of hookah smoking among white Americans: A pilot study

BACKGROUND Despite the sustained public health efforts to decrease cigarette smoking, there is an increasing trend in the use of alternative tobacco products that are perceived by some as less harmful. One example is hookah smoking. This study aimed to assess hookah trends among White Americans. METHODS Two hundred and forty-five White American adults residing in southeast Michigan answered a self-administered standardized questionnaire that included basic demographics, socioeconomic status, and questions related to hookah smoking behavior. Logistic regression was used to determine risk indicators for hookah smoking. RESULTS The combined prevalence of hookah smoking in the White American study population was 19%, with 10% of the sample smoking hookah only and 9% smoking both hookah and cigarettes. Approximately 19% of respondents believed that smoking hookah was less harmful than smoking cigarettes. Significant risk indicators for smoking hookah were being younger than 22 years and living with a family member who used tobacco. DISCUSSION In addition to reporting the prevalence of use in this important group of potential users, we outline important sociodemographic risk factors for hookah use in a non-Arab American population. More research is needed with a larger population to better understand this new tobacco trend in order to curb a new potential health threat.

Development and application of a population-based system for workplace violence surveillance in hospitals

BACKGROUND A unique and comprehensive reporting and population-based violence surveillance system in a multi-site hospital system is presented. METHODS Incidence rates and rate ratios (RR) were calculated by year, hospital, violence type, and job category in six hospitals, 2003-2008. RESULTS Incidence rates per hospital for the 6-year period ranged from a low of 1.52 to a high of 10.89 incidents/100 full-time equivalents (FTEs), with the highest risk at a hospital with an outpatient mental health facility (RR = 7.16, 95%CI = 5.17-10.26). Rates for worker-on-worker violence exceeded rates for patient-to-worker violence from 2004 to 2008. Mental health technicians (RR = 13.82, 95%CI =  1.13-17.29) and security personnel (RR = 2.25, CI = 1.68-3.00) were at greatest risk for violence. CONCLUSIONS This surveillance system provides ongoing information on professional groups and hospital departments at risk and trends in violence reporting over time. It can be used to determine where appropriate violence prevention efforts are most needed, and to evaluate violence interventions.

Underreporting of workplace violence: comparison of self-report and actual documentation of hospital incidents

This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.

Is patient involvement during hospitalization for acute myocardial infarction associated with post-discharge treatment outcome? An exploratory study

Objective  To investigate whether patient involvement during hospitalization for acute myocardial infarction (MI) was associated with health and behavioural outcomes 6–10 weeks after hospital discharge.

Intimate Partner Violence Among Iraqi Immigrant Women in Metro Detroit: A Pilot Study

Violence against women is an important public health problem. The objective of this study was to examine the prevalence of intimate partner violence (IPV) among immigrant Iraqi women, and to explore the association between IPV and self-rated health. A pilot study using a previously published, self-report questionnaire was carried out among a convenience sampling of 55 Iraqi women in greater Detroit. The overall prevalence of controlling behavior, threatening behavior, and physical violence was 93, 76, and 80%, respectively. Approximately 40% of the women reported having poor or fair health, and 90% reported experiencing one or more types of psychosomatic symptoms. Self-rated health was inversely related to exposure to threatening behavior and physical violence, and positively related to knowledge of one’s legal rights. The prevalence of IPV in this sample was high. Results indicated a significant association between exposure to IPV and women’s physical health and psychosomatic symptoms.

Organizational Climate Determinants of Resident Safety Culture in Nursing Homes

PURPOSE OF THE STUDY In recent years, there has been an increasing focus on the role of safety culture in preventing costly adverse events, such as medication errors and falls, among nursing home residents. However, little is known regarding critical organizational determinants of a positive safety culture in nursing homes. The aim of this study was to identify organizational climate predictors of specific aspects of the staff-rated resident safety culture (RSC) in a sample of nursing homes. DESIGN AND METHODS Staff at 4 Michigan nursing homes responded to a self-administered questionnaire measuring organizational climate and RSC. Multiple regression analyses were used to identify organizational climate factors that predicted the safety culture dimensions nonpunitive response to mistakes, communication about incidents, and compliance with procedures. RESULTS  The organizational climate factors efficiency and work climate predicted nonpunitive response to mistakes (p < .001 for both scales) and compliance with procedures (p < .05 and p < .001 respectively). Work stress was an inverse predictor of compliance with procedures (p < .05). Goal clarity was the only significant predictor of communication about incidents (p < .05). IMPLICATIONS Efficiency, work climate, work stress, and goal clarity are all malleable organizational factors that could feasibly be the focus of interventions to improve RSC. Future studies will examine whether these results can be replicated with larger samples.