Analysing workplace violence towards health care staff in public hospitals using alternative ordered response models: the case of north-eastern Turkey

The main objective of this article is to determine key factors that may have a significant effect on the verbal abuse, emotional abuse and physical assault of health care workers in north-eastern Turkey. A self-administered survey was completed by 450 health care workers in three well-established hospitals in Erzurum, Turkey. Because of the discrete and ordered nature of the dependent variable of the survey, the data were analysed using four distinctive ordered response models. Results revealed that several key variables were found to be a significant determinant of workplace violence, such as the type of health institution, occupational position, weekly working hours, weekly shift hours, number of daily patient contacts, age group of the respondents, experience in the health sector, training against workplace violence and current policies of the hospitals and the Turkish Ministry of Health.     

Workplace violence: a study of Turkish workers

This research was conducted to address the experience of workplace violence of Turkish workers from different sectors and to investigate the impact of the exposed violence on their psychological well-being. Data were collected anonymously with printed questionnaires from the volunteer participants and depended on self-reporting. The response rate was 79.0% (1708/2161). The prevalence of workplace violence was found to be 44.8%. The most common type was verbal violence together with mobbing (bullying). Victims of physical violence were mostly males, whereas females were found to be victims of verbal, psychological and sexual violence. Most cases did not result in legal action and the victims remained silent. Psychological well-being of exposed workers in terms of depression, anxiety and stress seemed to deteriorate. Workplace violence remains a silent epidemic in Turkey. Preventive measures against workplace violence and social support for violated workers do not exist.     

Frequency and determinants of recommended workplace violence prevention measures

PROBLEM: Limited information exists concerning adoption of workplace violence prevention measures by employers and the factors influencing their adoption. METHODS: A weighted sample of North Carolina workplaces (n=210) in operation January 1994 through March 1998 was used to estimate prevalence of 18 measures and identify community and workplace predictors of having >/=5 recommended measures. RESULTS: Location in a metropolitan area most strongly predicted presence of >/=5 administrative safety measures while a history of workplace violence and being in a high crime area were negatively associated. Belonging to an industry considered to be high-risk for workplace homicide was most strongly associated with having >/=5 environmental safety measures. DISCUSSION: Factors influencing high prevalence of violence prevention measures were related to business type, violence history, and location. Knowledge of factors influencing adoption of recommended workplace violence prevention measures can help tailor interventions to diverse industry settings. IMPACT ON INDUSTRY: An important contribution to the understanding and mitigation of workplace homicide is knowledge of the extent of implementation of recommended workplace violence prevention guidelines and factors influencing their adoption. Identifying factors that influence the prevalence and adoption of workplace violence safety interventions can help to tailor development of interventions to address the issue of workplace homicide across diverse industry settings.     

Exploring differences in the workplace violence experiences of young workers in middle and late adolescence in the United States

Problem: Young workers, typically characterized as 15–24 years of age, are commonly employed in jobs where the risk of workplace violence is high. It is unknown how these young workers, at varying stages of development, might understand and respond to workplace violence differently. We set out to explore whether the experiences and understandings of young workers varied between those in middle (ages 15–17) and late (ages 18–24) adolescence. Method: Separate focus groups were conducted with working students (n = 31), ages 15–17 and ages 18–24, who had either experienced or witnessed workplace violence. A focus group guide was used to facilitate the sessions which were recorded, transcribed, and content analyzed for themes. Results: Those in the older group experienced more severe episodes of sexual harassment and physical assault, reported using formal mechanisms for reporting, and noticed an employer focus on customer satisfaction over employee safety, while the younger participants tended to report to their parents. Both groups reported negative effects of experiencing workplace violence including depression, anxiety, feelings of worthlessness, and spill over into personal life. Discussion: Findings suggest that young workers at different developmental stages may experience and respond to workplace violence differently. Further research is needed to see if these results are generalizable. Summary: It is imperative that we understand the distinct differences between these subsets of young workers and how they experience and respond to workplace violence in order to improve research, policy development, and prevention/intervention mechanisms. Practical Applications: Understanding that differences exist among young workers based on age due to developmental stage, lack of experience, education, and social awareness can enable employers, companies, policy makers, and researchers the opportunity to better address the issue of workplace violence in this population.     

医务人员职业健康危害及其关键控制环节

通过查阅、分析大量文献,结合实际工作经验,系统阐述了医务人员面临的主要职业危害因素,并针对我国医务人员职业危害现状和防治工作中存在的主要问题,提出防治关键环节和措施。分析表明:我国医务人员职业暴露危害严重;医务人员的生命质量和平均寿命低于普通人群;医院职业卫生立法和技术标准滞后;防治措施不力,医务人员职业健康权益得不到有效保护。同时指出对医务人员职业危害防治的关键措施:必须通过加强科学研究、制定法规标准、建设医院安全文化、加强宣传教育和培训、推广免疫接种和防护技术、科学设计工作流程、加强心理疏导等关键措施,有效防治医务人员职业健康危害。     

Occupational exposure to human immunodeficiency virus (HIV)--how can we reduce the risk?

We analyzed occupational exposure to potentially infectious body fluids among health care workers (HCWs). Nurses were the most common exposed category of HCWs. In 73.6% cases needle sticks had been the reason of exposure. Recapping a needle was the cause of exposure in 6.9% accidents. Among 189 registered HCWs, 66 (34.9%) performed invasive procedures without any personal protective equipment. Prophylaxis with antiretroviral drugs was necessary in 43 (22.8%) cases. As many as 60.3% of exposure incidents to potentially infectious material result from non-compliance with the relevant recommendations. Continuous education and training is critically needed to prevent occupational exposure to blood-borne infections among health care workers.     

The Relationship Between Psychosocial Work Factors,Work Stress and Computer-Related Musculoskeletal Discomforts Among Computer Users in Malaysia

We analyzed occupational exposure to potentially infectious body fluids among health care workers (HCWs). Nurses were the most common exposed category of HCWs. In 73.6% cases needle sticks had been the reason of exposure. Recapping a needle was the cause of exposure in 6.9% accidents. Among 189 registered HCWs, 66 (34.9%) performed invasive procedures without any personal protective equipment. Prophylaxis with antiretroviral drugs was necessary in 43 (22.8%) cases.

As many as 60.3% of exposure incidents to potentially infectious material result from non-compliance with the relevant recommendations. Continuous education and training is critically needed to prevent occupational exposure to blood-borne infections among health care workers.     

The need for detailed gender-specific occupational safety analysis

IntroductionThe female work in population is growing in the United States, therefore the occupational health and safety entities must start to analyze gender-specific data related to every industry, especially to nontraditional occupations. Women working in nontraditional jobs are often exposed to extreme workplace hazards. These women have their safety and health threatened because there are no adequate policies to mitigate gender-specific risks such as discrimination and harassment. Employers tend to aggravate this situation because they often fail to provide proper reporting infrastructure and support. According to past studies, women suffered from workplace injuries and illnesses that were less prominent among men. Statistics also confirmed that men and women faced different levels of risks in distinct work environments. For example, the rates of workplace violence and murders by personal acquaintances were significantly higher among women.MethodsIn this paper, the authors analyze prior public data on fatal and nonfatal injuries to understand why we need to differentiate genders when analyzing occupational safety and health issues.ResultsThe analyses confirmed that women dealt with unique workplace hazards compared to men.ConclusionsIt is urgent that public agencies, such as the U.S. Department of Labor, record gender-specific data in details and by occupations and industries.Practical applicationThe reader will become aware of the current lack – and need – of data and knowledge about injuries and illnesses separated by gender and industry. Finally, safety and health researchers are encouraged to investigate the gender-specific data in all industries and occupations, as soon as they become available.     

OHS inspectors and psychosocial risk factors: Evidence from Australia

Legislation giving prominence to psychosocial risk factors at work has changed the role of government occupational health and safety (OHS) inspectors in many countries. Yet little is known about how inspectorates have responded to these changes. Between 2003 and 2007 an Australian study was undertaken on OHS standards, entailing detailed documentary analysis, interviews with 36 inspectorate managers and 89 inspectors, and observations made when researchers accompanied inspectors on 120 typical workplace visits. Our study found that general duty provisions in OHS legislation clearly incorporated psychosocial hazards and inspectorates had introduced guidance material, pursued campaigns and increased interventions in this area. However, the regulatory framework remained narrow (focused on bullying/harassment, occupational violence and work stress) and workplace visits revealed psychosocial hazards as a marginal area of inspectorate activity. These findings were reinforced in interviews. While aware of psychosocial hazards inspectors often saw the issue as problematic due to limited training, resourcing constraints, deficiencies in regulation and fears of victimisation amongst workers. In order to address these problems a number of changes are required that recognize the distinctiveness of psychosocial hazards including their ‘invisibility’. Notable here are revisions to regulation (both general duty provisions and specific codes), the development of comprehensive guidance and assessment tools to be used by inspectors, greater use of procedural enforcement, and enhanced inspectorate resourcing and training. There is also a need to recognize complex inter-linkages between psychosocial hazards and the industrial relations context.     

Environmental evaluation for workplace violence in healthcare and social services

PROBLEM: Federal policy recommends environmental strategies as part of a comprehensive workplace violence program in healthcare and social services. The purpose of this project was to contribute specific, evidence-based guidance to the healthcare and social services employer communities regarding the use of environmental design to prevent violence. METHOD: A retrospective record review was conducted of environmental evaluations that were performed by an architect in two Participatory Action Research (PAR) projects for workplace violence prevention in 2000 and, in the second project in 2005. Ten facility environmental evaluation reports along with staff focus group reports from these facilities were analyzed to categorize environmental risk factors for Type II workplace violence. RESULTS: Findings were grouped according to their impact on access control, the ability to observe patients (natural surveillance), patient and worker safety (territoriality), and activity support. DISCUSSION: The environmental assessment findings reveal design and security issues that, if corrected, would improve safety and security of staff, patients, and visitors and reduce fear and unpredictability. IMPACT ON INDUSTRY: Healthcare and social assistance employers can improve the effectiveness of violence prevention efforts by including an environmental assessment with complementary hazard controls.     

Reducing Musculoskeletal Discomfort: Effects of an Office Ergonomics Workplace and Training Intervention

Effects of an office ergonomics workplace and training intervention on workers’ knowledge and self-reported musculoskeletal pain and discomfort were investigated. An instructional systems design process was used to develop an office ergonomics training program and the evaluation tools used to measure the effectiveness of the training program on workers’ office ergonomics knowledge and skills. It was hypothesized that the training and workplace intervention would allow the worker to more effectively use their workplace through increased office ergonomics knowledge and skills. Following the intervention, there was a significant increase in workers’ office ergonomics knowledge and awareness. Self-reported work-related musculoskeletal disorders significantly decreased for the group who had a workplace change and received ergonomic training relative to a workplace change-only group and a no intervention control group.     

Foundational workplace safety and health competencies for the emerging workforce

IntroductionYoung workers (aged 15–24) suffer disproportionately from workplace injuries, with a nonfatal injury rate estimated to be two times higher than among workers age 25 or over. These workers make up approximately 9% of the U.S. workforce and studies have shown that nearly 80% of high school students work at some point during high school. Although young worker injuries are a pressing public health problem, the critical knowledge and skills needed to prepare youth for safe and healthy work are missing from most frameworks used to prepare the emerging U.S. workforce.MethodsA framework of foundational workplace safety and health knowledge and skills (the NIOSH 8 Core Competencies) was developed based on the Health Belief Model (HBM).ResultsThe proposed NIOSH Core Competencies utilize the HBM to provide a framework for foundational workplace safety and health knowledge and skills. An examination of how these competencies and the HBM apply to actions that workers take to protect themselves is provided. The social and physical environments that influence these actions are also discussed.ConclusionsThe NIOSH 8 Core Competencies, grounded in one of the most widely used health behavior theories, fill a critical gap in preparing the emerging U.S. workforce to be cognizant of workplace risks.Practical applicationsIntegration of the NIOSH 8 Core Competencies into school curricula is one way to ensure that every young person has the foundational workplace safety and health knowledge and skills to participate in, and benefit from, safe and healthy work.     

CDC's research portfolio in older adult fall prevention: a review of progress, 1985-2005, and future research directions

PROBLEM: Falls are a leading cause of mortality and morbidity among adults age 65 and older. Population models predict steep increases in the 65 and older population bands in the next 10-15 years and in turn, public health is bracing for increased fall rates and the strain they place on health care systems and society. To assess progress in fall prevention, the Centers for Disease Control and Prevention conducted a research portfolio review to examine the quality, relevance, outcomes and successes of the CDC fall prevention program and its impact on public health. METHODS: A peer review panel was charged with reviewing 20 years of funded research and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis for extramural and intramural research activities. Information was collected from grantees (via a survey instrument), staff were interviewed, and progress reports and products were reviewed and analyzed. RESULTS: CDC has invested over $24,900,000 in fall-related research and programs over 20 years. The portfolio has had positive impacts on research, policies and programs, increasing the public health injury prevention workforce, and delivering effective fall prevention programs. DISCUSSION: Public health agencies, practitioners, and policy makers recognize that while there are some evidence-based older adult fall prevention interventions available, many remain unused or are infeasible to implement. Specific recommendations across the public health model, include: additional research in gathering robust epidemiologic data on trends and patterns of fall-related injuries at all levels; researching risk factors by setting or sub-population; developing and testing innovative interventions; and engaging in translation and dissemination research on best practices to increase uptake and adoption of fall prevention strategies. CDC has responded to a number of suggestions from the portfolio review including: funding translation research of a proven Tai Chi fall intervention; beginning to address gaps in gender, ethnic, and racial differences in falls; and collaborating with partner organizations who share in CDC's mission to improve public health by preventing falls and reducing fall-related injuries. IMPACT ON INDUSTRY: Industry has an opportunity to develop more accessible and usable devices to reduce injury from falls (for example, hip protectors and force reducing flooring). By implementing effective, evidence-based interventions to prevent falls and reduce injuries from falls, significant decreases in health care costs can be expected.     

A qualitative investigation of factors affecting school district administrators’ decision to adopt a national young worker curriculum

Introduction: Even though the majority of youth in the U.S. work, and workers under the age of 18 are seriously injured on the job at higher rates when compared to adults, most adolescents lack instruction on workplace safety and health. Method: This qualitative study examines the extent to which selected U.S. school districts provide workplace safety and health instruction to students and explores the factors that influence districts’ decision to adopt a free, foundational occupational safety and health (OSH) curriculum. Results: Results from key informant interviews conducted with a purposive sample of 34 school administrators revealed that only a third of the districts have at least 75% of their students receive some instruction on workplace safety and health, while 15% indicated they provide no instruction on this topic. District staff who indicated that they provide OSH instruction stated that it is most often taught through career and technical education (CTE; 65%) and/or health classes (26%). They believed the benefits of providing this instruction include assisting students to get jobs (38%) and helping students learn about safety (32%), while competing demands (44%) and time constraints (41%) were identified as barriers to providing OSH education to students. Conclusions: Given the importance of work to teens and their increased risk of work injury, interested stakeholders—including parents, teachers, employers, and the public health community—should promote the inclusion of workplace safety and health instruction in U.S. secondary schools. Practical Applications: This research fills a gap in current knowledge about the extent to which OSH is currently taught within U.S. secondary schools, enumerates barriers and facilitators to the inclusion of workplace safety and health instruction in schools, presents a free, foundational curriculum in workplace safety and health, and provides directions for future research on the vital role schools can play in preparing the future workforce for safe and healthy employment.     

农民工职业危害防护需求意愿调查分析

为了调查农民工职业危害防护的具体需求意愿及他们对企业职业危害管理现状的认知,分析农民工职业危害防护需求意愿与农民工职业危害防护行为之间的关系。采用问卷调查的定量调查方法进行调查。调查对象中男性农民工409人,女性农民工157人。参与问卷调查的农民工,均接触一种及以上的职业性有害因素。调查内容包括了解公司预防和控制职业病的政策,参与公司的职业危害管理决策,实施的职业性健康安全培训、健康监护、个人防护用品的使用等预防和控制职业病的管理措施等方面,本次调查显示,农民工对于预防职业危害表现出强烈的需求愿望,且对企业的职业危害防护现况表示了不满,倾向于采取极端的行为维护自身的健康权益。但另一方面,农民工实际参与企业职业危害防护的行为率较低,与他们的需求意愿相比有明显的差距。     

New tools and strategies for the inspection of the psychosocial working environment: The experience of the Danish Working Environment Authority

In 2007 the Danish Working Environment Authority launched a new strategy to strengthen and qualify primary prevention of work related stress. Part of the strategy consists of increased inspections of the psychosocial working environment as well as the development and implementation of a new inspection tool, namely the “guidance tool”.Twenty-four sector specific guidance tools have been developed to help WEA inspectors assess psychosocial working environment problems in all Danish enterprises. Based on recent research, the guidance tools consist, in each sector, of the three to five most important risk factors (for example quantitative demands, emotional demands, and work related violence), as well as the most important preventive factors, e.g. quality of management, influence/control and training.During the first years of the strategy, an increasing number of inspectors have issued improvement notices regarding work related stress and violence, and there has been an increasing number of notices issued on several risk factors. For some aspects, the tools have helped increase the clarity and comprehensibility of the improvement notices and reduce the WEA’s time consumption per enterprise.The guidance tools seem to be a suitable and efficient way of assessing several health and safety risks concerning work related stress and violence thereby allowing the WEA to detect more of the existing problems. Future challenges projected for the strategy include continuously training all WEA inspectors in the proper use of the tools and continuously refining the tools – or developing new tools – based on further research and experiences from practice.     

A research model--forecasting incident rates from optimized safety program intervention strategies

INTRODUCTION/PROBLEM: Property damage incidents, workplace injuries, and safety programs designed to prevent them, are expensive aspects of doing business in contemporary industry. The National Safety Council (2002) estimated that workplace injuries cost $146.6 billion per year. Because companies are resource limited, optimizing intervention strategies to decrease incidents with less costly programs can contribute to improved productivity. METHOD: Systematic data collection methods were employed and the forecasting ability of a time-lag relationship between interventions and incident rates was studied using various statistical methods (an intervention is not expected to have an immediate nor infinitely lasting effect on the incident rate). RESULTS/SUMMARY: As a follow up to the initial work, researchers developed two models designed to forecast incident rates. One is based on past incident rate performance and the other on the configuration and level of effort applied to the safety and health program. Researchers compared actual incident performance to the prediction capability of each model over 18 months in the forestry operations at an electricity distribution company and found the models to allow accurate prediction of incident rates. IMPACT ON INDUSTRY: These models potentially have powerful implications as a business-planning tool for human resource allocation and for designing an optimized safety and health intervention program to minimize incidents. Depending on the mathematical relationship, one can determine what interventions, where and how much to apply them, and when to increase or reduce human resource input as determined by the forecasted performance.     

A new training specification for workplace health promotion

The field of workplace health promotion has seen developments of concepts, practice and interest in recent years. However, recent EC wide research has pointed to problems which constrain its development. These include a lack of awareness amongst the major players who are in a position to implement workplace health promotion, difficulties in transmitting the concept of and organising genuine inter-disciplinary approaches to workplace health promotion, and a lack of training courses in the area.This paper describes a project to develop a training specification for workplace health promotion targeted at a range of professional and non-professional groups. These include occupational physicians and nurses, safety engineers, personnel managers, health and safety representatives and others.The project has developed a modular training specification — each trainee group can undertake all modules to an appropriate level of detail. It focuses on two broad areas — the health promotion process and the roles necessary to support that process. The first area defines an idealised health promotion process, which has been divided into 7 phases, while the second area outlines 6 principal roles in relation to interacting with that process. Future work will see the implementation of the training specification in a number of test sites.     

Globalization and workplace hazards in developing nations

Multinational corporations are rapidly introducing hazardous technological activities into less-developed nations. There is considerable evidence that this feature of global commerce poses risks to health, safety and natural resources, and most immediately endangers the workers involved. The less-developed nations hosting these activities are vulnerable to exploitation of their human resources because they lack the safeguards, expertise, and public pressures that prevent harms to workers in developed nations. This paper presents an evaluation of approaches taken by international and industrial organizations to address workplace hazards by soft law, hard law, codes of conduct, and voluntary self-regulation. Finding that these approaches have repeatedly failed, a new approach is presented for the purpose of assuring that the transfer of technology will be accompanied by the transference of practices for using it safely. The key features of this approach are then considered: defining a standard of care which aims to provide equivalent treatment of worker health and safety across all nations, irrespective of their level of development, and establishing contractual relationships between multinational companies and host countries as a feasible means of implementing the standard and achieving equivalent treatment.