Patience, Violence & Other Stories of Change
On Monday, May 28, , at the age of 21, he ended his life. Eileen Chang had lost her only son to a mysterious malady the medical world has only recently acknowledged Claire Friedman was not the mother-in-law of sitcoms and punchlines. She was active, vibrant and loved by friends and family. So when Bernie Weinstein walked into the hospital that day in and saw his mother-in-law restrained in a chair, he was shocked.
Little Mataya gives the gift of change. The doctor sat down, arranged the kids around him, and began the story. No recommendations were made. A daughter honours her father through a teaching career in nursing. Judy never kept her pledge. She did not give up on nursing. In fact, she threw herself into a There was an elderly woman in the bed. Her face was badly swollen and bruised. Her lip was stitched and her knee gashed. She looked like an assault victim. Claire inspires change after her passing.
Now friendships were at stake, along with the nursing job she loved in a Newfoundland hospital. Go home and learn how to breathe through this," he said. To her mother, Tanya, he added, "Don't waste your money on an ambulance. Baby Sophia helped create policy change. She was but 18 weeks old when her mom, Tania, delivered the stillborn girl into a place of confusion, fear and bureaucratic technicality. Lack of mental health care places teenager at risk. Denice Klavano had just lost one of her beloved sons, and now the life of a second was hanging in the balance. As far as this desperate mom was concerned, the mental health service that should have been there to rescue her boy was failing miserably.
Klavano's year from hell began Yes, Fervid Trimble was 87 years old. She was ill with an apparent flu. A worried phone call from Fervid had been enough of a concern for family to initially take her to an His mom Donna was out of the room when Vance asked what seemed like a strange question. But they repeatedly said it was minor — barely more When providing care, put the patient into perspective.
How did year old Ambrose Wald fall out of a hospital chair specifically designed to stop patients from falls? It's a question to which his daughter Irene Wald, a nurse of almost 35 years, has never received an answer. No real investigation took place as to what happened to my dad," says The comfort of a little dog in her hospital bed, thanks to a compassionate blind eye turned by her nurses, meant the world to Jeri-Joann Lyddiatt. Jeri-Joann, or J-J to almost everyone who knew her in her hometown of Ingersoll, Ontario, died of ovarian cancer in June, , at the age of Born with a mild learning disability, she functioned Barb Farlow was 22 weeks pregnant when her prenatal diagnosis revealed her daughter had Trisomy 13 and The genetic condition sees many babies die before birth, during labour, or shortly after birth.
Just 10 ten per cent of children survive beyond one year, living disabled but happily with their families. There are resources available to assist advocates and decisionmakers. The Green Guide for Health Care is an extensive toolkit providing recommendations for design, construction, renovation, operations, and management of sustainable causing reduced occupational and environmental effects and healthier buildings.
Working in nursing increases the risk of experiencing both minor and major psychiatric morbidity , with job strain contributing to this outcome. Mental disorders such as major depression, anxiety disorders, and psychotic disorders are less common, but they can be induced or exacerbated by work stress.
These fall into two categories: Allostatic load is a theoretical concept whereby excessive demands and a persistent sympathetic adrenergic load on the body produce changes in neuronal, immune, and cardiovascular system structure and function, thus having a detrimental impact on bodily processes. High physical demands, fast-paced work, adverse work schedules, role stressors, career insecurity, difficult interpersonal relationships, nonstimulating jobs, and lack of autonomy have been associated with symptoms of anxiety and depression, several psychoses, and with substance use disorders.
Extended work schedules have been associated with a variety of mental health indicators in nursing and in other occupations where these schedules are common. Proctor and colleagues found that both the number of overtime hours and the number of cumulative days worked by automotive workers were associated with changes in mood States such as depression and tension. Hospital interns reported subjective deterioration in mood after long shifts. Depression and anxiety have also been shown to vary with the level of work pace, variety, control, social support, and conflicting demands made on workers.
Fatigue is thought to be a central nervous system stressor. Nursing is emotionally demanding, with both emotional labor and the need to witness and bear with suffering taking its toll. Emotional labor is necessary to display socially appropriate emotions that are congruent with the job requirements in face-to-face interactions with patients.
The more frequent and intense the interpersonal interactions are with others staff, visitors, patients , requiring the nurse to expend emotional effort, the more likely the nurse will experience symptoms of burnout, including depersonalization and emotional exhaustion. The authors stated that no recommendations on the most effective approach were possible due to the small number of studies. In a larger meta-analysis of both nurses and other workers, a moderate effect for cognitive-behavioral interventions and multimodal interventions was found, along with a small but significant overall effect for relaxation techniques.
Organizational interventions were not significant; however, the authors posit that combining individual-level skills e. From to, 1. Yet, only about half 46 percent of all incidents were reported to the police. The health care sector leads all other industries, with 45 percent of all nonfatal assaults against workers resulting in lost workdays in the United States, according to the U. In these two facilities, the survey found an assault incidence rate of per employees per year, compared to hospital incident report rates of only 35 per Environmental and organizational factors have been associated with patient and family assaults on health care workers, including understaffing especially during times of increased activity such as meal times , poor workplace security, unrestricted movement by the public around the facility, and transporting patients.
Emergency department personnel also face a significant risk of injuries from assaults by patients or their families. Those carrying weapons in emergency departments create the opportunity for severe or fatal injuries. California and Washington State have enacted standards requiring safeguards for emergency department workers. Although mental health and emergency departments have been the focus of attention and research on the subject, no department within a health care setting is immune from workplace violence. Consequently, violence prevention programs would be useful for all departments.
The first report to the Nation on workplace violence underscores the lack of systematic national data collection on workplace assaults, the paucity of data evaluating violence prevention strategies, and the methodological flaws in published intervention research to date. All were quasi-experimental and without a formal control group. Runyan and colleagues criticized the design of published violence prevention interventions to date because of their lack of systematic rigor in the evaluation.
She calls for greater reliance on conceptual and theoretical models to guide research as well as stronger evaluation designs. This study found that the intervention hospitals reported significantly more violence incidents than the control hospitals. The authors attributed this finding to increased awareness of the violence and improved supervisory support at the intervention facilities. There is no Federal standard that requires workplace violence protections.
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California and Washington State both have legislation addressing workplace violence in health care settings. Between and , Lipscomb and colleagues conducted an intervention effectiveness study to describe a comprehensive process for implementing the OSHA Violence Prevention Guidelines and evaluate its impact in the mental health setting. Program impact was evaluated by a combination of quantitative and qualitative assessments. Results of the comparison of the change in staff-reported physical assaults were equivocal.
Many psychiatric settings now require that all patient care providers receive annual training in the management of aggressive patients, but few studies have examined the effectiveness of such training. However, implementation of comprehensive violence prevention programs that go beyond staff training will improve safety of the health care workplace for all workers.
These advanced programs include the use of currently available engineering and administrative controls such as security alarm systems, adequate staffing, and training. While there is increasing evidence linking nursing work environments to nurse health, much more effort has focused on understanding how work influences satisfaction and performance. Improving data and measures will allow better comparisons across studies and build evidence of which relationships are most important.
Varied approaches are used to compile data about the nursing work environment. Measures of work characteristics have varied considerably and are most often related to the particular discipline and study objectives. In occupational health, the traditional assessments of exposure have expanded from obvious physical and chemical exposures to include psychosocial demands, physical demands, and leadership quality.
A self-administered paper-and-pencil or electronic questionnaire is probably the most common approach to gathering information from nurses. The advantages over observation or interviews are obvious: Yet, these same advantages can also be disadvantages: The level of the data may also be unclear. Some items may explicitly reflect the work group or organization, while others may reflect both.
Clarity is needed about how many respondents is optimum to represent a particular level of analysis. Worker outcome data may be solicited from an individual through self-report interviews or questionnaires. These data are subject to the same limitations noted above, although nurse reports are more likely to yield detailed information about potential factors contributing to their health. Measuring nurse health outcomes also is challenging. No matter how data are collected, there can be some measurement error in assessing adverse health outcomes—and attributing them to the work environment.
Many of these issues have been discussed in the sections on adverse health outcomes. For example, musculoskeletal injuries become chronic conditions and may not be attributed to the work. Another source that is rarely used is administrative data e. Unfortunately, these statistics may not reflect minor injuries requiring only first aid or injuries that can be episodic and remitting, such as back injuries, majors concerns for nurses.
The FROIs serve as a more complete source of potentially claimable injuries to health care workers than WC data as they represent all reported injuries, even those that do not lead to lost work time or a medical claim. Relying on WC claims data without using FROI data may introduce systematic selection biases because studies have shown that WC claims are more likely to be filed by workers who are unionized, working for a company too small to be self-insured, or who are more severely injured.
WC is concerned with compensating injured or ill workers, while the OSHA Occupational Injury and Illness Recording and Reporting Requirements Act is designed to develop a database that can improve understanding of injury and illness, with the intent to prevent them. Thus, certain injuries and illnesses may be reportable under both systems, while others will be reportable under State WC law or under the OSHA recordkeeping rule. State WC benefit requirements also vary, with some States not requiring lost time, but requiring that the employee sought medical care.
Unfortunately, ascertainment of nursing health outcomes varies across these data. For example, injured workers may seek care from their regular health provider and fail to mention the work-relatedness of the injury. In a cross-sectional study of unionized autoworkers diagnosed with work-related MSDs, only 25 percent filed WC claims. The need for standardization in data collection and measuring both work environment and worker outcomes is not new. As noted by NIOSH, insufficient job data to link work factors to health outcomes is a barrier to research. An international conference on linked employer-employee data was held in to address issues of confidentiality, levels of analysis, and the need for coordination across Federal and State agencies.
Unfortunately, data policy changes at the Federal and local levels are often slow to occur, as modifications to existing systems require long and arduous lobbying, legislation, and procedure and policy development before implementation. Moreover, the WC regulations are primarily State driven, and this is unlikely to change. Researchers are encouraged to use established instruments and items, with established reliability and validity.
If they are developing their own instruments, psychometric testing is essential. Findings benchmarked with other similar populations are useful to determine variation and explore sources of measurement error. When assessing work environments, the level of analysis for the measure must be explicit e. Analytical strategies should be used to account for the multilevel nature of the data. Administrative data for worker injuries can be very useful. Many health care organizations are implementing programs that are likely to affect both patient and worker safety, yet it may be difficult to efficiently evaluate the effectiveness of these programs.
Ohio, for example, has used the claims data to support issuance and evaluation of safety grants used in lifting and other mechanical equipment purchases to reduce employee injuries. In this chapter, we have focused on the major injury and safety issues for working nurses. Some of these issues have been thoroughly researched, with extensive evidence-based findings available for epidemiology and prevention, whereas others remain to be studied and explained. As indicated, there is great potential for preventing nurse injury, even though many risk factors have yet to be addressed.
The benefits of improvements to nurse safety are great, both for retaining nurses and attracting new nurses into the profession. As many facilities are making important financial investments and system-level improvements to promote patient safety, it is important to leverage these efforts to improve worker safety as well. In the long run, these improvements will also benefit patients, as measures that are taken to improve safety for nurses should lead to a healthier and more effective workforce.
As our chapter encompassed multiple outcomes, search terms varied depending on the category, and included but were not limited to, e. The findings and conclusions in this chapter are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.
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Turn recording back on. National Center for Biotechnology Information , U. Show details Hughes RG, editor.
Author Information Authors Alison M. Background The safety of nurses from workplace-induced injuries and illnesses is important to nurses themselves as well as to the patients they serve. Research Evidence Shift Work and Long Work Hours The relationship between work schedules and health and safety is complex and is influenced by characteristics of the work schedule time of shift, direction and speed of rotation, pattern of days off, shift length, rest breaks , as well as characteristics of the job, the worker, and the work environment.
Risks Associated With Shift Work Sleep, sleepiness, performance, safety Drake and coworkers 8 indicated that 32 percent of night workers majority of shift hours between 9 p. Social and familial disruptions Because shift workers often work in the evening and sleep during the day, they frequently sacrifice participation in social and family activities.
Long-term effects and vulnerable groups Although the specific contribution of shift work to other illnesses is not clear, several diseases have been associated with these work schedules. Risks Associated With Long Work Hours The number of studies examining long work hours is less extensive, but a growing number of findings suggest possible adverse effects. Coping Strategies Efforts to promote adaptation to or ease the difficulties of coping with shift work and long work hours include strategies for employers and strategies for workers.
Nurse Injury and Disease Outcomes Musculoskeletal Injuries Few industries in the United States have undergone more sweeping changes over the past decade than the health care industry. Interventions for MSD Three common interventions used to prevent work-related musculoskeletal injuries associated with patient handling are 1 classes in body mechanics, 2 training in safe lifting techniques, and 3 back belts. Needlesticks Health care workers continue to be exposed to the serious and sometimes life-threatening risk of blood-borne infections in a wide variety of occupations and health care settings.
Chemical Occupational Exposures There are thousands of chemicals and other toxic substances to which nurses are exposed in practice. Volatile organic compounds Volatile organic compounds VOCs are chemicals that readily evaporate at room temperature, thus allowing the chemicals to be easily inhaled. Sterilants As an example, ethylene oxide EtO and glutaraldehyde are commonly used in medical settings for sterilization. Medications Many medications and compounds in use in personal care products have known toxic effects. Pesticides Pesticide use, both inside and outside of hospitals and health facilities, is another cause for concern.
Latex exposure Latex allergy due to exposure to natural proteins in rubber latex is also a serious problem in health care workers. Summary of Key Issues Regarding Harmful Exposures An awareness of the repercussions of exposure to chemicals and toxins has prompted action to reduce such exposures in health care settings. Mental Health Effects of Nursing Work Working in nursing increases the risk of experiencing both minor and major psychiatric morbidity , with job strain contributing to this outcome.
Violence From to, 1. Research Implications Challenges in Measuring Nursing Working Conditions and Nurse Safety Outcomes While there is increasing evidence linking nursing work environments to nurse health, much more effort has focused on understanding how work influences satisfaction and performance. Nurse Health Outcomes Worker outcome data may be solicited from an individual through self-report interviews or questionnaires. Conclusion In this chapter, we have focused on the major injury and safety issues for working nurses. Evidence Table Personal Safety for Nurses.
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