The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences

Workplace violence is an important health and safety issue. Healthcare workers are particularly at risk of experiencing workplace violence. Despite the research that was conducted in this domain, little is known about the consequences of being a victim of workplace violence, specifically in the healthcare sector. Therefore, this article aims to review the literature regarding the consequences of exposure to workplace violence in the healthcare sector. Sixty-eight studies were included in the review and they were evaluated according to 12 criteria recommended for systematic reviews. The studies identified seven categories of consequences of workplace violence: (1) physical, (2) psychological, (3) emotional, (4) work functioning, (5) relationship with patients/quality of care, (6) social/general, and (7) financial. Psychological (e.g., posttraumatic stress, depression) and emotional (e.g., anger, fear) consequences and impact on work functioning (e.g., sick leave, job satisfaction) were the most frequent and important effects of workplace violence. In conclusion, this paper recommends further research, particularly longitudinal studies, in order to better grasp the direct and indirect effects of workplace violence.     

Linking team resources to work-family enrichment and satisfaction

Work-family scholars now recognize the potential positive effects of participation in one life domain (i.e., work or family) on performance in other life domains. We examined how employees might benefit from team resources, which are highly relevant to the modern workplace, in both work and nonwork domains via work-family enrichment. Using the Resource-Gain-Development model (Wayne, Grzywacz, Carlson, & Kacmar, 2007), we explored how team resources contribute to enrichment and resulting project and family satisfaction. Using multilevel structural equation modeling (ML-SEM) to analyze student data (N = 344) across multiple class projects, we demonstrated that individuals with team resources were more likely to experience both work-to-family and family-to-work enrichment. Further, enrichment mediated the relationship between team resources and satisfaction with the originating domain.     

Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings

Health reform, post the passing of the Patient Protection and Affordable Care Act, has highlighted the need to better address critical issues such as primary care, behavioral health, and payment reform. Much of this need is subsequent to robust data showing the seemingly uncontrollable growth of healthcare costs, and the exacerbation of these costs for patients with comorbid behavioral health and medical conditions. There is increasing recognition that incorporating behavioral health in primary care leads to improved outcomes and better care. To address these problems, primary care will play critical roles across the healthcare system, especially in the delivery of behavioral health services. Psychologists are uniquely positioned to take advantage of this propitious moment and can help facilitate the integration of behavioral and primary care by developing competencies in integrated care, training a capable workforce, and advocating for integrated care as the status quo.     

Lack of Detachment and Impaired Sleep Connect Perceived Unfairness with Health Complaints: a Population-Based Mediation Test

In a sample of 8223 working individuals, representative for Swiss employees, a lack of detachment from daily problems and sleep problems were tested to mediate the association between experienced unfairness in life and health problems. Mediation was compared with respect to the life domain of unfairness (work life or private life), sex and age (ages 18 to 45 and older than 45). Unfairness at work and private unfairness were tested separately with mutual control of other domains of unfairness. In an analysis of overall unfairness in life, unfairness in both domains was summed up. Both life domains of unfairness were related directly and indirectly with health problems. All indirect paths were significant. The sum of unfairness at work and unfairness in private life showed the strongest direct and indirect association with health problems. Sleep problems turned out to be a stronger mediator than lack of detachment. Differences in mediation between men and women were not significant. Sleep problems were a significantly stronger mediator in older, compared with younger, individuals. Sleep problems seem to connect experienced unfairness at different life domains with health impairments. The study adds knowledge to the health-related interplay of work, leisure, and sleep.     

Moving European research on work and ageing forward: Overview and agenda

This longitudinal retrospective study shows that when the results of an organizational development intervention are fed back properly and action plans are made, factors associated with leadership and commitments to organization are enhanced. The study compared the effects of survey feedback, including the making of action plans and survey feedback without action plans, to the effects of no feedback at all on several psychosocial factors and sick leave over a 3-year period. The data were derived from 1236 individuals for whom baseline data were available and who completed a 3-year follow-up. Applied statistics revealed that the feedback action plan group reported greater improvements regarding leadership factors and commitment to the organization. The results reveal no differences between the feedback groups in regard to sick leave. There is a need for further studies, preferably with a randomized control design, on how to enhance both the psychosocial work environment and employee health and also how to reduce sick leave in the workplace.     

Asking for work adjustments or initiating behavioural changes – what makes a ‘problematic co-worker’ score Brownie points? An experimental study on the reactions towards colleagues with a personality disorder

People with mental disorders, especially personality disorders, often face low acceptance at work. This is particularly problematic when returning to work after sick leave, because it impedes reintegration into the former workplace. This study explores colleagues’ reactions towards a problematic worker dependent on the returning person’s reintegration strategy: The returning person undertaking changes in their behaviour is compared with the person requesting adjustments of the workplace. In an experimental study, 188 employed persons read one of four vignettes that described a return-to-work-situation of a problematic co-worker. Across all vignettes, the co-worker was depicted as having previously caused problems in the work team. In the first vignette, the co-worker did not change anything (control condition) when she returned to work; in the second, she asked for workplace adjustments; in the third vignette she initiated efforts to change her own behaviour; and the fourth vignette combined both workplace adjustments and behavioural change. Study participants were asked for their reactions towards the problematic co-worker. Vignettes that included a behavioural change evoked more positive reactions towards the co-worker than vignettes without any behavioural change. Asking for workplace adjustments alone did not yield more positive reactions compared to not initiating any change. When preparing employees with interactional problems for their return to work, it is not effective to only instruct them on their statutory entitlement for workplace adjustments. Instead, it is advisable to encourage them to proactively strive for behaviour changes.     

Health Related Quality of Life in Children with Congenital Heart Disease

Health-related quality of life in children with congenital heart disease (CHD) was compared to that of healthy children. Furthermore, agreement between child and parent reports was examined. In addition, differences in quality of life related to the severity of CHD were evaluated. One hundred children with CHD aged between 8-18 years and their parents answered a health-related quality of life-questionnaire during their visit to the paediatric cardiology outpatient department. CHD children reported reduced motor functioning and autonomy compared to healthy children. Parents of children with CHD reported their children to have a reduced quality of life in the domains of: motor functioning, autonomy and cognitive functioning. Agreement between child and parent reports was moderate. Children systematically reported lower health related quality of life on the domain of positive emotions than did parents. Health related quality of life in children with CHD appeared not to be influenced by severity of the disease. In conclusion, regardless of the severity of the disease, children with CHD reported their health related quality of life on several domains to be lower than that of healthy children. This means that on several domains, the emotional impact of problems in health status is greater for children with CHD than for healthy children. When CHD patients visit the clinic, it is important that physicians actively ask patients as well as parents about the child's motor functioning, autonomy and cognitive functioning. Children with problems in these domains can then be identified, and psychological interventions can take place at an early stage.     

Collaborative Communication Between Psychologists and Primary Care Providers

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient’s primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient’s confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan.     

Counterproductive behaviors: Relations across life domains,etiology, and implications for applied practice

Previous research on counterproductive work behavior (CWB) has shown that workplace deviance can be predicted from individual differences and environmental variables, but relatively little is known about CWBs’ relations with counterproductive behaviors in other domains of an individual's life. Data from 500 male twins were used to examine relations among counterproductive behaviors from several life domains, including school, non‐work, substance use, and work. The results supported the hypotheses that counterproductivity in work and a variety of personal life domains, previous and contemporaneous, are strongly and positively related. A general counterproductivity factor, giving rise to rule‐ and norm‐breaking behavioral repertoire of individuals, accounted for approximately half the variance across measures of counterproductivity in specific life domains. To inform theory and research, the etiology of inter‐individual differences in counterproductivity was examined. Biometric analyses revealed that most of the variance in the counterproductivity domains examined, including CWB, is attributable to genetic and unique (nonshared) environmental factors. The general counterproductivity factor spanning different counterproductivity domains was most influenced by genetic factors (75.4%), but was also influenced by unique environmental factors (24.6%). Biometric analyses indicated that 27% of the variance in CWB is attributable to genetic influences arising from the general factor of counterproductivity and 20% from genetic factors specific to CWB. Unique environmental influences associated with the work domain explained 12% of the variance in CWB. For the CWB criterion, regression analyses explored the usefulness of information from other counterproductivity domains for prediction and employee selection. Counterproductivity from academic and non‐work domains are potent predictors of counterproductivity at work (multiple Rs ranging between .50 and .54).     

The Prescribing Clinical Health Psychologist: A Hybrid Skill Set in the New Era of Integrated Healthcare

The prescribing clinical health psychologist brings together in one individual a combination of skills to create a hybrid profession that can add value to any healthcare organization. This article addresses the high demand for mental health services and the inequitable distribution of mental health practitioners across the nation. The close link between physical and mental health and evidence that individuals in psychological distress often enter the mental health system via primary care medical clinics is offered as background to a discussion of the author??s work as a commissioned officer of the U.S. Public Health Service assigned to the Chaparral Medical Center of La Clinica de Familia, Inc. near the U.S.?CMexico border. The prescribing clinical health psychologist in primary care medical settings is described as a valuable asset to the future of professional psychology.     

Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial

The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return-to-work intervention (RTW-I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW-I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW-I posttreatment, but COMBO did not differ from CBT or RTW-I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW-I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.     

Measuring health status and quality of life in HIV and AIDS

Abstract

HIV can diminish quality of life profoundly, and it is important to understand and measure such effects of HIV and its treatments Although the term quality of life is commonly used, “health status” more accurately describes dimensions that are directly health related and that may be affected by traditional interventions. There is a substantial literature on general health status measurement, and several of the most established measures have been applied or adapted for use in HIV infected populations These measures include the Medical Outcomes Study health ratings, the Quality of Well-Being scale, and the Sickness Impact Profile. Cancer-specific measures such as the EORTC Quality of Life Core Questionnaire and the CARES have also been adapted. In the last three years, health status measures for HIV have been completed by several thousand patients, and have generally proved to be reliable and valid indicators of relevant clinical differences such as disease stage, numbers of symptoms, and other psychometic measures of disability and distress. Health status measures were included in a few completed clinical trials, and are being incorporated in a growing number of antiretroviral and antimicrobial studies. Health status measures provide the best way to evaluate psychosocial interventions directly aimed at improving patients' quality of life. Although challenges remain in further developing health status measures for HIV disease and in applying them, measurement of these concepts has proved to be both technically and operationally feasible. Measures of health status and quality of life can play an important role in the evaluation of clinical treatments in research studies, directing clinical treatment, assessing changes in health care delivery, and planning health care services.     

Feeling frugal: socioeconomic status,acculturation, and cultural health beliefs among women of Mexican descent

Psychosocial and socioeconomic variables are often confounded. The authors combined quantitative with grounded theory analysis to investigate influences of acculturation, socioeconomic status (SES), and cultural health beliefs on Mexican-descent women's preventive health behaviors. In 5 focus group interviews sampling across levels of acculturation and SES, women expressing more traditional Mexican health beliefs about breast cancer screening were of lower SES and were less U.S. acculturated. However, SES and acculturation were uncorrelated with screening behaviors. Qualitative analysis generated hypotheses about joint influences of SES and traditional health beliefs; for example, low-SES women may learn frugal habits as part of their cultural traditions that influence their health care decision making, magnifying SES-imposed structural restrictions on health care access.     

Employee recognition: A procedure to reinforce work attendance

An employee recognition program to improve work attendance was conducted for one year in 1986 as part of a 3-year study using the awarding and posting of attendance certificates as the primary method of employee recognition. Compared to sick leave usage during 1985, those employees in the recognition group decreased their use of sick leave by 28%. In 1987, the year following the end of the recognition program, the average sick leave returned to a level higher than the 1986 level. In addition, the sick leave of a nonintervention control group of employees showed a sequential increase each year from 1985 to 1987, with their use in 1986 being 16% greater than those employees in the employee recognition group.     

Life satisfaction and health related quality of life among low-income medical patients: The mediating influence of self-esteem

This study investigated the relationship between life satisfaction, self-esteem, and perceived health for an ethnically diverse, low SES sample of primary care patients. Results indicated that several specific domains of health-related quality of life (HRQL), including health perception, social functioning, mental health, and energy/fatigue, significantly predicted life satisfaction in this sample of 60 patients. Self-esteem mediated this relationship, partially with health perception and fully with the remaining three domains. The results of this study underscore the importance of healthcare interventions that consider the bidirectional relationship between physical and emotional well-being.     

Translating policy principles into practice to improve health care access for adults with intellectual disabilities: a research review of the past decade

This article extracts principles from two Surgeon General reports, Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation (2002) and Call to Action to Improve the Health and Wellness of Persons with Disabilities (2005), and combines them with the Objectives from Chapter 6 of Healthy People 2010 to create a policy framework. This framework is used to review literature from the past decade on access to health care and health promotion for persons with intellectual and developmental disabilities (IDD). Review of the literature indicates an emerging evidence base for health promotion programs for persons with IDD. Research in health care and health promotion access requires improvements in surveillance and measurement of quality of life, as well as increased participation of persons with IDD and their families in its implementation. While international guidelines for primary health care have been developed for people with IDD, US guidelines are specialty focused and address specific conditions. Despite its recognized importance, there is surprisingly little information on training programs for health care providers to improve care of persons with IDD. Financing of health care continues to threaten access to comprehensive care for persons with IDD, particularly regarding coordination of care and availability of providers who accept Medicaid patients. Community-based sources of health care have been slow to emerge, and there is clear need for assumption of responsibility for providing care to persons with IDD. Future US policy should include consideration of environmental factors in health care access.     

Anxiety Disorders Among Older Primary Care Patients

Data from the 1997 National Ambulatory Medical Care Survey (NAMCS) were accessed to obtain information about naturalistic patterns of recognition, service utilization, and treatment for late-life anxiety in primary care. The NAMCS is a national probability sample survey of office visits to non-Federal, U.S. physicians engaged in patient care. The survey was conducted by the Division of Health Care Statistics, National Center for Health Statistics, and Centers for Disease Control and Prevention (CDC). Data are now in the public domain. For the current report, all cases indicating office visits for patients age 60 and older were selected (n = 7,687). Anxiety disorders were assigned for 1.3% (n = 99) of these visits, with anxiety disorder NOS the most frequent diagnosis. For 20.2% of these visits (n = 20), a coexistent depressive disorder also was diagnosed. Depression without coexistent anxiety was diagnosed for 2.3% of all visits (n = 176). These figures suggest that late-life anxiety may often go unrecognized and may be more difficult to detect than depression. Nevertheless, other data indicate that appropriate pharmacological treatment and mental health services or referrals are often provided when anxiety or depression is recognized. However, visits wherein these disorders are recognized require increased physician time, and significant proportions of patients in some groups may still not receive appropriate mental health care. Results are discussed in terms of the nature of usual care for late-life anxiety and the needs for future research.     

Domain-specificity in perfectionism: Variations across domains of life

Perfectionism has been assessed in relation to salient or narrow domains within specific populations, yet little is understood across broader domains of life. The aim was to assess positive perfectionism (PP) and negative perfectionism (NP) in five broad domains; university/work, relationships, physical activity, domestic environment and appearance and to determine any gender differences within domains. One hundred and forty four university students (females n = 101; males n = 43) completed a modified perfectionism measure for each domain. Correlations within and between domains for PP and NP ranged from low to moderate with differential patterns by gender, supporting more domain specificity and less of a universal trait. Repeated measures ANOVAs revealed that, overall, PP and NP in the university/work domain was significantly higher than all other domains. Females reported greater PP in the university domain compared to other domains, and more PP in the relationship, domestic environment and appearance domains as compared to the physical activity domain. In contrast, males reported significantly higher PP in the physical activity domain. Females reported significantly higher NP in the university and appearance domains, while males had similar NP across all domains. These findings present a more complex picture of perfectionism with implications for domain-specificity in perfectionistic behavior.     

Queer Patients and the Health Care Professional—Regulatory Arrangements Matter

This paper discusses a number of critical ethical problems that arise in interactions between queer patients and health care professionals attending them. Using real-world examples, we discuss the very practical problems queer patients often face in the clinic. Health care professionals face conflicts in societies that criminalise same sex relationships. We also analyse the question of what ought to be done to confront health care professionals who propagate falsehoods about homosexuality in the public domain. These health care professionals are more often than not motivated by strong religious convictions that conflict with mainstream medical opinion on homosexuality. We argue that they ought to be held accountable for their conduct by their professional statutory bodies, given that they abuse their professional standing to propagate sectarian views not representative of their profession. Lastly, we propose that medical schools have special responsibilities in training future health care professionals that will enable them to respond professionally to queer patients seeking health care.     

An evaluation of a hospital-based trainee counselling psychology practitioner's service

Counselling psychology is in its infancy in the National Health Service. There is a professional need to evaluate what its practitioners do and with what outcomes. This study is of the work of a trainee counselling psychologist, in a clinical psychology department, and covers his work over 30 months from first appointment. Numerical data were accessed from historical records relating to the author's three working areas: a psychiatric hospital's outpatient department; a university's student health service; and a short-contact primary care counselling clinic. A sample of closed-case clients from the hospital outpatients and the student health service was contacted, and sent questionnaires to elicit their views on the service received. Primary care clients were excluded from this part of the study because of service dissimilarity to the other working domains and access problems. Case loads, case types, frequencies and distributions of client attendances and non-attendances were examined, compared and contrasted using tables, graphs and statistical methods. Clients’ questionnaire responses were tabulated and commented on. It was apparent that although the same general pattern of anxiety-clustered cases predominated in each working area, in other respects the service demands were different. The data have relevance for service design, staffing and management.