Pamela F. Levin

Violence in the workplace.

This integrative review of research on workplace violence in Canada and the United States showed that risk factors for homicide and nonfatal assault injuries differed significantly. In 1993, there were 1,063 work-related homicides in the United States (Bureau of Labor Statistics, 1994). Workplace homicide was the second leading cause of fatal occupational injuries overall, but the primary cause for women. The highest risk for workplace homicide was observed among males, the self-employed, and those employed in grocery stores, eating and drinking establishments, gas service stations, taxicab services, and government service, including law enforcement. The majority of workplace homicides occurred during robberies. Unlike workplace homicide, the majority of nonfatal assaults that involved lost work time occurred to women, primarily employed in health care or other service sector work. The assault rates for residential care and nursing and personal care workers were more than ten times that of private non-health care industries. Minimal intervention research has been reported. In recent years, some governmental agencies and professional organizations have begun to address policy issues related to workplace violence.

Assault of long-term care personnel.

The purpose of this study was to explore contributing factors, consequences, and solutions to assault of long-term care personnel. The study sample consisted of three focus groups composed of certified nursing assistants and administrators employed in long-term care facilities within a large Midwestern city. Using content analysis methodology, multiple themes emerged: worker attitude, vulnerability, work culture, job tasks, training, working short-staffed, financial concerns, changes in social values and health care, community crime, substance abuse, accepting assaults, coworker threats, issues of retaliation, professional withdrawal, and inability to share experiences. Preventive measures suggested by the participants are consistent with those recommended by the Occupational Safety and Health Administration. Implications for staff and administrators include both personal and workplace strategies. Recommendations include implementing more comprehensive violence prevention programs that includes conflict management and training tailored to the type of residents.

Workplace homicides in Chicago. Risk factors from 1965 to 1990.

Using data from police records, this study examined risk factors related to 940 workplace homicides occurring in Chicago between 1965 and 1990. Black men were predominantly both victims (49%) and offenders (75%). The median age for victims was 42 years, but only 25 years for offenders. Women (40%) were more likely than men (6%) to be killed by intimates. Firearms were involved in 83% of all homicides, and robbery was the primary motive (62%). Workplace homicides occurred most frequently in taverns (22%). Alcohol use by tavern workers was involved in 48% of the homicides. Wide disparity in the number of workplace homicides occurred in Chicagos 77 community areas. Strategies to deter robbery and alcohol use, as well as to prevent domestic violence in the workplace, need to be implemented and evaluated. Occupational health nurses play a pivotal role in effective violence prevention.

Injuries associated with teacher assaults: magnitude, nature, cost, and outcome

The purpose of this retrospective study was to describe the magnitude, nature, and costs of assault injuries among teachers, a high-risk group. Review of assault cases (N = 341) was based on internal and case management vendor records. The 3-year assault rate was 3.24 per 1,000 teachers. Assaults were predominately physical, occurring during classroom disputes and while restraining students. Assaults accounted for 2,480 lost workdays and more than

Workplace violence: female occupational homicides in metropolitan Chicago.

714,000 in lost wages and case management fees. The most costly injuries on a per-case basis were strain-sprain injuries resulting in lost workdays and fractures not resulting in lost workdays. Less than 20% of the assaults accounted for all of the lost workdays and most of the case costs. Study variables accounted for 13% of case costs. Occupational health nurses should collaborate with school personnel, administrators, and parents to develop prevention programs, which may include de-escalation techniques for teachers as well as case management strategies.

Enhancing compliance with universal precautions.

Homicide is the leading cause of fatal occupational injuries for women and accounts for 39% of all fatal injuries for women at work. Using medical examiner and coroner reports, this study analyzed female workplace homicides in three counties within metropolitan Chicago from 1984 to 1990. These workplace homicides were compared to non-workplace homicides of women. There were 1,354 female homicides; of the 17 workplace homicides, all occurred in Cook County. The annual rate of female occupational homicides was higher (1.5/105) for Cook County, while for the metropolitan Chicago area (Cook, DuPage, and Lake counties) it was 1.19/105. Black women experienced a higher workplace homicide rate (2.3/105) than white women (1.2/105). Most of these occupational homicides occurred in retail trade, predominately in eating and drinking establishments; robbery was a frequent occurrence, and the women often worked alone. Only three medical examiner reports cited a known assailant. The leading cause of death was from gunshot wounds. Workplace homicides were similar to non-workplace homicides in relation to age, race, and cause of death. Identified risk factors associated with workplace homicides, as well as non-fatal assaults, should be used to develop effective preventive measures. A national standard for general workplace security also is needed.

Insights of nurses about assault in hospital-based emergency departments

Dr. Lusk is Associate Professor and Director, Occupational Health Nursing, The University of Michigan School of Nursing, Ann Arbor, MI. Pamela F. Levin, PhD, RN, is Clinical Assistant Professor, Department of Public Health Nursing, University of Illinois at Chicago, Chicago, IL. T he AIDS epidemic has increased recognition that health care workers face risks of illness and death from exposures during their work. Transmission of hepatitis B through exposure to blood was known well before AIDS, but was not generally recognized as a serious hazard. While the risks for health care workers of acquiring or dying from hepatitis B is much greater than from AIDS, the latter has been emphasized in most professional and lay literature. The AIDS epidemic may actually have provided an unexpected benefit to health care workers by calling attention to the hazards associated with exposure to blood and body fluids, resulting in development of controls to prevent exposure to HIV and the hepatitis viruses. The first efforts to protect health care workers from this hazard called for Universal Precautions-the use of personal protective equipment (PPE) whenever there was potential for ex-