Nancy M. Nachreiner

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.

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.

Effectiveness of Education and Individualized Counseling in Reducing Environmental Hazards in the Homes of Community-Dwelling Older Women

OBJECTIVES: To test the effectiveness of an education and counseling intervention on reducing environmental hazards in the homes of older women.

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.

Child bystanding: A risk factor for injury and identifying its' determinants on midwestern agricultural operations

BACKGROUND Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operations. We evaluated the incidence and determinants of associated bystander injuries in the Regional Rural Injury Study-II (RRIS-II). METHODS The RRIS-II followed 32,601 people ( approximately 85% of eligible) from rural communities in the Midwest for 1999 and 2001, using six-month recall periods, and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews. Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury, while controlling for potentially confounding variables. RESULTS Nearly 60% of all 425-child injury cases (<20 years) responded to sometimes/frequently bystanding in six out of seven different agricultural environments (e.g., workshops, animal areas, etc.) Multivariate regression analyses, with odds ratios and 95% confidence intervals, showed increased odds of injury for bystanding near used (1.5; 1.1, 1.9) or stored (1.4; 1.1, 1.8) machinery, and near fields and barnyards (1.4; 1.0, 1.9). Further, multivariate analyses revealed increased odds of bystanding for parental beliefs, such as: child age (1.4; 1.0, 2.0) near stored equipment. Parental levels of strictness were also evaluated and showed decreased odds of bystanding when the parents were not strict about the childs wearing a seatbelt near used equipment (0.5; 0.3, 1.0). Households with only one child had decreased odds of bystanding for five of the exposures while there was an increased odds of bystanding near animals for households with five or more children. CONCLUSIONS Although parents cannot child-proof their operations, it is important for them to understand the apparent odds of and risks associated with bystanding. Children can have injury odds similar to adults in this environment; therefore, it is necessary to examine parental factors that may be associated with childrens likelihood of bystanding in high-risk work environments.

Crosscutting competencies for occupational health and safety professionals

A change from a quarter system to a semester system presented a convenient opportunity for faculty at the Midwest Center for Occupational Health and Safety (a 27-year-old National Institute for Occupational Safety and Health-sponsored education and research center) to evaluate the current curriculum. As part of this process faculty identified both individual and crosscutting competencies for four programs: Occupational Medicine, Occupational Health Nursing, Industrial Hygiene, and Occupational Injury Epidemiology and Control. Faculty identified potential competency sets using published literature, course objectives, and content summaries. Common themes, termed crosscutting competencies, were identified. Seventy program graduates (58%) responded to a survey designed to assess the value of, and proficiency in, these competencies based on their postgraduation job experience. All 29 crosscutting competencies were rated as valuable or very valuable by respondents in each of the four programs. There was less agreement between respondents in proficiency ratings, with 24 of 29 competencies rated either proficient or very proficient. Comparing value and proficiency provided an opportunity to further refine the curriculum and a model for enhancing the skills, knowledge, and attitudes of future environmental and occupational health professionals. With further testing, we propose this set of crosscutting competencies be considered for adoption as a set of interdisciplinary core competencies for Occupational Health and Safety professionals.

Written violence policies and risk of physical assault against Minnesota educators.

Few research studies on school violence policies use quantitative methods to evaluate the impact of policies on workplace violence. This study analyzed nine different written violence policies and their impact on work-related physical assault in educational settings. Data were from the Minnesota Educators’ Study. This large, nested case control study included cases (n=372) who reported physical assaults within the last year, and controls (n=1116) who did not. Multivariate logistic regression analyses, using directed acyclic graphs, estimated risk of assault. Results of the adjusted multivariate model suggested decreased risks of physical assault were associated with the presence of policies regarding how to report sexual harassment, verbal abuse, and threat (OR 0.53; 95 per cent CI: 0.30–0.95); assurance of confidential reporting of events (OR 0.67; 95 per cent CI: 0.44–1.04); and zero tolerance for violence (OR 0.70; 95 per cent CI: 0.47–1.04).

Preplacement assessments. Impact on injury outcomes

Evaluation of the impact of preplacement assessments is important given the resources companies and occupational health nurses allocate to screening and the ambiguity of the literature about the effectiveness of such assessments. This study examined the effects of preplacement assessments on employee injuries. All individuals screened by an occupational health clinic in the upper Midwest and given work restrictions during a 3 year period were identified as cases (n=67). Cases were matched with controls without work restrictions (n=264) on the basis of employer, gender, and job. Age was controlled for statistically. Chi-square analysis, used to test differences in percent distribution of injuries between cases and controls, found no statistically significant differences in musculoskeletal injuries between the groups. Work restrictions recommended as a result of preplacement assessments appear to protect vulnerable workers.

Risk of physical assault against school educators with histories of occupational and other violence: a case-control study.

A case-control study design was used to investigate risks of work-related physical assault (PA) associated with a history of violent victimization among educators. A total of 6,469 state-licensed educators (Kindergarten - Grade 12) worked in the previous 12~months and were eligible to participate. Exposure data were collected from cases (reporting a PA event in previous 12 months, n=290) for the month before PA, and from controls (no work-related PA in previous 12 months; n=867) for a randomly selected working month. Odds ratios and 95% confidence intervals identified increased risks for educators with any prior history of work-related (17.3, 11.4-26.3) or non-work-related PA (2.0, 1.2-3.5). In addition, PA risk in the previous twelve months increased with the number of previous victimizations, and risk also increased for educators with histories of non-physical violence (work- and non work-related). The results present a compelling case for targeted interventions and further research.

A survey of community-based violence prevention and control efforts in Minnesota.

Rates of interpersonal violence at the national level in the United States exceed those of other industrialized nations; evidence of violence exists at the state level as well. Yet, data that identify the magnitude of the problem, pertinent risk factors, and efficacy of intervention efforts are limited. Faculty at the University of Minnesota School of Public Health conducted a survey to assess the extent to which violence prevention research and programmatic efforts exist statewide. Study findings served as a basis for developing a relevant research agenda and prioritizing limited academic resources. This paper describes the survey and development of an academic-community partnership that fosters collaborative research on violence prevention that will hopefully contribute to control of the violence epidemic.