FINAL PROGRESS REPORT Title Page PrincipalWorkplace violence (WPV) is a serious and growing problem...

FINAL PROGRESS REPORT

Gillespie, Gordon Lee, PhD 1R13OH010135‐01 of 19

Title Page Principal Investigator: Gordon Lee Gillespie, PhD, RN University of Cincinnati College of Nursing Assistant Professor P.O. Box 210038 Cincinnati, OH 45221‐0038 P: 513.558.5236 E: [email protected] Institution: Mary Ucci University of Cincinnati Director, Grants Management Division 51 Goodman Dr., Suite 530 P.O. Box 210222 Cincinnati, OH 45221‐0222 Project Title: National Conference for Workplace Violence Prevention and Management in Healthcare

Settings Co‐ Investigator: Donna M. Gates, EdD, RN, FAAN University of Cincinnati College of Nursing Assistant Professor P.O. Box 210038 Cincinnati, OH 45221‐0038 Sponsors: University of Cincinnati College of Nursing P.O. Box 210038 Cincinnati, OH 45221‐0038 Emergency Nurses Association 931 Lee St. Des Plaines, IL 60016‐6569 Grant No.: 1R13OH010135‐01 Date: August 29, 2012



Table of Contents

Content Page

Title page 1

Table of contents 2

List of terms and abbreviations 3

Abstract 4

Section 1 5

Significant (key) findings 5

Translation of findings 5

Outcomes/impact 6

Section 2 7

Science report 7

Publications 18

Inclusion of children 19

Materials available for other investigators 19



List of Terms and Abbreviations NORA National Occupational Research Agenda U.S. United States WPV workplace violence



Abstract Title: National Conference for Workplace Violence Prevention and Management in Healthcare Settings Investigator: Gordon Lee Gillespie, University of Cincinnati, College of Nursing, Cincinnati, OH 45221 (Email: [email protected]) Affiliation: University of Cincinnati State: OH Telephone: 513.558.5236 Award Number: 1R13OH010135‐01 Start & End Dates: 07/01/2011‐06/30/2012 Program Area: Safety and Occupational Health Final Report Abstract: Workplace violence (WPV) is a serious and growing problem for healthcare workers. Workplace violence includes acts of incivility, bullying, verbal and physical aggression, threatening words or actions, sexual harassment, and physical assaults. Although research in the field of WPV has been growing in recent years, there has been a lack of opportunities for researchers who study WPV in the healthcare sector to meet and share findings, theories, and models. Currently researchers in this study area are few and scattered throughout the U.S. Now more than ever there was a critical need for a U.S. based conference to be held where the leaders, innovators, educators, and researchers could come together to network, build multi‐disciplinary teams, and share strategies, potential solutions, educational materials, best practices, and findings related to the prevention, management, and recovery associated with WPV. This conference was the first national U.S. conference in recent history specifically focusing on WPV in healthcare settings. The conference was held over 2 ½ days from Friday, May 11, 2012 to Sunday, May 13, 2012 at the Marriot Kingsgate Conference Center at the University of Cincinnati Academic Health Center. The conference hosted four keynote sessions, seven papers sessions, and three poster sessions. Conference objectives (specific aims) were (1) discuss the current epidemiology of incivility, bullying, verbal and physical aggression, threatening words or actions, sexual harassment, and physical assaults enacted against healthcare workers, (2) evaluate intervention programs aimed at preventing and reducing the incidence and sequelae of workplace violence against healthcare workers by visitors, patients, coworkers, and intimate partners, and (3) analyze whether the questions raised during the University of Iowa Injury Prevention Research Center summit of 2000 have been addressed. Program evaluations from the conference attendees indicated that the conference objectives for discussing the current epidemiology and evaluating intervention programs were met. On the final day of the conference, a panel discussion and consensus building session was hosted and video recorded. Ultimately, the panel members concluded that the state of the science for workplace violence has improved in terms of violence from patients, visitors, and coworkers; however, there remains a great gap in terms of personal relationship violence, multidisciplinary populations, and the description and testing of interventions aiming to prevent, manage, and recover from the workplace violence that occurs in healthcare settings.



Section 1 Significant (Key) Findings: Specific Aim 1: Discuss the current epidemiology of incivility, bullying, verbal and physical aggression, threatening words or actions, sexual harassment, and physical assaults enacted against healthcare workers. Each conference attendee was asked to rate their agreement that the 1st conference objective (Specific Aim 1) was met based on a Likert rating of 1‐strongly disagree to 5‐strongly agree. The mean score for this item was 4.65 indicating that conference attendees strongly agreed that this conference objective was met. Specific Aim 2: Evaluate intervention programs aimed at preventing and reducing the incidence and sequelae of workplace violence against healthcare workers by visitors, patients, coworkers, and intimate partners. Each conference attendee was also asked to rate their agreement that the 2nd conference objective (Specific Aim 2) was met based on a Likert rating of 1‐strongly disagree to 5‐strongly agree. The mean score for this item was 4.6 indicating that conference attendees strongly agreed that this conference objective was met. Specific Aim 3: Analyze whether the questions raised during the University of Iowa Injury Prevention Research Center summit of 2000 have been addressed. The panel members concluded that the state of the science for workplace violence has improved in terms of violence from patients, visitors, and coworkers; however, there remains a great gap in terms of personal relationship violence, multidisciplinary populations, and the description and testing of interventions aiming to prevent, manage, and recover from the workplace violence that occurs in healthcare settings. Translation of Findings: While the findings have not been translated to practice yet, we have received several inquiries to have the sessions posted to the conference webpage for use by researchers and practitioners. During the fall quarter, the conference proceedings will become freely available to the public for this purpose. The panel session was video recorded and will also become available. The panel session provides specific recommendations for future research and health policy. Researchers and practitioners reviewing the conference proceedings and panel session may translate the information directly to their respective practices. In an effort to further “push” the translation of findings to practice, we are working on a special edition of a peer‐reviewed interdisciplinary journal. Thirteen presenters have agreed to write full manuscripts for inclusion in this special edition. Recommendations for practice will be included in the manuscripts to targeting practitioners and researchers alike.



Outcomes/Impact: Potential outcomes of the conference include increased interdisciplinary research. During the networking opportunities, several attendees were discussing having speakers coming to their respective practice environments (e.g., emergency department) to conduct a risk assessment, speak with their administrators on environmental design and risk reduction, and collaborate on future research. The panel session was a key element to the conference. During the panel session there were specific research recommendations to continue to advance the state of the science for workplace violence research in healthcare settings.



Section 2 Science Report: Background Workplace violence places an incredible burden upon employees, patients, and employers (Arimatsu et al., 2008; Gacki‐Smith, Juarez, Boyett, Homeyer, Robinson, & MacLean, 2009; Gates, Gillespie, Smith, Rode, Kowalenko, & Smith, 2011; Li, Juarez, & Gates, 2010; NIOSH, 2009). The negative effects of workplace assaults for employees include minor and serious physical injuries, temporary and permanent physical disability, decreased productivity, psychological trauma, and death (Fry et al., 2002; Gates, Gillespie, & Succop, 2011; Gillespie, Gates, Miller, & Howard, 2010; McKinnon & Cross, 2008; NIOSH, 2002). Less severe violence such as incivility, bullying, threats, and verbal aggression have also been linked to the negative employer outcomes of insomnia, anxiety, depression, and decreased work productivity (Felblinger, 2008; Gillespie et al., 2010; Hutton & Gates, 2008; Murray, 2009). Adverse consequences to employers for lower level violence include increased absenteeism, employee turnover, and decreased organizational commitment (Felblinger, 2008; Gillespie et al., 2010; Murray, 2009). It is also believed that there is a direct consequence to the safety of patients as a result of WPV and a worker’s inability to remain focused and productive at work (Felblinger, 2008; Gates et al., 2011; Gillespie et al., 2010). Workplace violence has been a problem for many years, unfortunately there was no clear direction on where the state of the science for WPV research should be focused. In 2000, the University of Iowa Injury Prevention Research Center (2001) in collaboration with NIOSH and the National Center for Injury Prevention and Control addressed the need for a scientific direction of WPV research. The organizations sponsored a WPV intervention research workshop to develop an agenda for WPV research. Key stakeholders from academia, governmental agencies, police, insurance, and private industry participated. The outcome from the workshop was specific WPV research recommendations for general industry. Despite this phenomenal step towards directing the future of WPV research, there was and continues to be minimal interventions conducted for the prevention, management, or recovery from WPV. Healthcare settings have unique risk factors and circumstance in relation to violence. For example, healthcare providers find it nearly impossible to legally refuse care to violent persons and are not able to leave the work setting due to the risk of being charged with patient abandonment. There remains a significant need for novel interventions to tackle the problem of WPV in healthcare settings. The completed conference allowed the collection and dissemination of research to the scientific community; thereby, depicting the research progress that specifically relates to healthcare settings made since the seminal conference in April 2000. Specific Aims Workplace violence (WPV) is a serious and growing problem for healthcare workers. Workplace violence includes acts of incivility, bullying, verbal and physical aggression, threatening words or actions, sexual harassment, and physical assaults. Although research in the field of WPV has been growing in recent years, there has been a lack of opportunities for researchers who study WPV in the healthcare sector to meet and share findings, theories, and models. Currently researchers in this study area are few and scattered throughout the U.S. Now more than ever there was a critical need for a U.S. based conference to be held where the leaders, innovators, educators, and researchers could come together to network, build multi‐disciplinary teams, and share strategies, potential solutions, educational materials, best



practices, and findings related to the prevention, management, and recovery associated with WPV. This conference was the first national U.S. conference in recent history specifically focusing on WPV in healthcare settings. The completed conference was specifically relevant to the National Occupational Research Agenda (NORA) (NORA Healthcare and Social Assistance Sector Council, 2009). The Healthcare and Social Assistance Council established a NORA specific plan and strategy to promote safe and healthy workplaces. The objectives of this conference assisted the National Institute for Occupational Safety and Health (NIOSH) to meet their mission to address the NORA Healthcare and Social Assistance Council’s strategy for safe and healthy workplaces. The specific objectives of this conference were to:

1. Discuss the current epidemiology of incivility, bullying, verbal and physical aggression, threatening words or actions, sexual harassment, and physical assaults enacted against healthcare workers.

2. Evaluate intervention programs aimed at preventing and reducing the incidence and sequelae of workplace violence against healthcare workers by visitors, patients, coworkers, and intimate partners.

3. Analyze whether the questions raised during the University of Iowa Injury Prevention Research Center summit of 2000 have been addressed.

Methodology

Call for abstracts and conference advertisement. The Conference Committee partnered with the Emergency Nurses Association (ENA, Des Plaines, IL) for the call for abstracts as well as conference advertisement. Additionally, the continuing education coordinators for the U.S. Educational Research Centers (ERCs) affiliated with the CDC‐NIOSH disseminated the conference call for abstracts and advertisements to the constituents of their respective listservs. An invitation was also emailed directly to 678 researchers that published findings of workplace violence research (based on literature search using SCOPUS peer‐reviewed journal database); deans of U.S. colleges of nursing, psychology, and criminal justice; and presenters of workplace violence research at recent occupational health conferences.

Peer review. Fifty abstracts were received and underwent a double‐blind peer review process by three independent peer reviewers. The double‐blind peer review process was managed by UC Conference and Event Services. Peer reviewers were from the disciplines of criminal justice, medicine, nursing, pharmacy, and psychology. Abstracts were rank‐ordered based on their meritorious score from highest to lowest. Authors of the highest ranked abstracts were offered to be a paper presenter. Some authors preferred to be a poster presenter and were assigned to a poster session per their request. Authors not accepted for a paper session were offered to be a poster presenter. Ultimately, 43 abstracts were accepted for presentation at the conference.



Results The conference was held over 2 ½ days from Friday, May 11, 2012 to Sunday, May 13, 2012 at the Marriot Kingsgate Conference Center at the University of Cincinnati Academic Health Center. The conference hosted four keynote sessions, seven papers sessions, and three poster sessions. On site management with attendees, speakers, and the hotel/conference was coordinated by UC Conference and Event Services. The four keynote presenters were Drs. Paula Grubb, David Yamada, Scott Bresler, and Donna Gates. Dr. Paula Grubb is a research psychologist with CDC‐NIOSH and spoke on Incivility in the Workplace. Dr. David Yamada is a Professor of Law and the Director of the New Workplace Institute at the Suffolk University Law School. He spoke on Workplace Bullying in Healthcare. Dr. Scott Bresler is a psychologist and Clinical Director in the Division of Forensic Psychiatry at the University of Cincinnati. His presentation was titled Physical Violence against Healthcare Workers. Dr. Donna Gates is an adjunct faculty with the University of Cincinnati College of Nursing. She spoke on the Environmental Context of Workplace Violence.

Paper sessions. There were twenty abstracts presented during the seven paper sessions. A summary of the paper sessions is provided in Table 1. Table 1. Poster abstracts presented during the conference.

Session Presenter Abstract Title

Paper session 1: Epidemiology of workplace violence in healthcare settings

Traci Galinsky, Research Psychologist, CDC‐NIOSH, Cincinnati, OH

Assaults of workers by patients in home health care

Julie Shaw, Sr. Clinical Director Emergency Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Staff perceptions of workplace safety in a pediatric emergency department

Marilyn Ridenour, CDC‐NIOSH, Morgantown, WV

Shift differences of workplace violence on psychiatric staff

Paper session 2: A global perspective of workplace violence

AnnMarie Papa, Clinical Director Emergency Nursing, Hospital of the University of Pennsylvania, Glenside, PA

What is violence? An international perspective

Ahlam Al‐Natour, Doctoral Student, University of Cincinnati College of Nursing, Cincinnati, OH

Violence against Jordanian nurses by the intimate partner or family member




Paper session 3: Developing our human resources for the management of workplace violence

Daniel Hartley, Epidemiologist, CDC‐NIOSH, Morgantown, WV

Workplace violence prevention on‐line course: Research and development

Maryalice Nocera, Project Director of the Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC

Workplace violence prevention training and the prevalence of physical assault among home health and hospice workers

Peggy Berry, Doctoral Student, University of Cincinnati College of Nursing, Cincinnati, OH

The effects of workplace bullying on the productivity of novice nurses

Paper session 4: Workplace incivility and bullying

Shellie Simons, Assistant Professor Nursing, University of Massachusetts Lowell, Sharon, MA

A qualitative study of coping strategies used by nurses experiencing bullying at work

Vicki Magley, Associate Professor Psychology, University of Connecticut, Storrs, CT

Initial evaluation of the civility among healthcare professionals (CAHP) workshop

Wendy Budin, Director of Nursing Research, NYU Langone Medical Center

Relationships among verbal abuse from nurse colleagues and demographic characteristics, work attributes, and work environment of early career registered nurses

Paper session 5: Novel approaches for addressing workplace violence

Judith Arnetz, Associate Professor, Department of Family Medicine and Public Health Science, Wayne State University School of Medicine, Detroit, MI

Using database reports to reduce workplace violence: Perceptions of hospital stakeholders

John‐Robert Curtin, Founding Director of the 4Civility Institute, Louisville, KY

Workplace incivility, harassment, and bullying in healthcare organizations: Practical solutions to create a health healthcare environment

Adam Hill, Clinical Director, Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Measureable results: Reducing staff injuries on a specialty psychiatric unit for patients with developmental disabilities




Paper session 6: The integration of theory to practice for workplace violence

Christian Burchill, Clinical Nurse IV, Emergency Department, University of Pennsylvania Health System, Philadelphia, PA

Factors that influence perceptions of personal safety for emergency nurses: Development of a valid assessment tool

Linda Robinson, Clinical Nurse, Emergency Department, St. Elizabeth Healthcare, Edgewood, KY

Workplace violence prevention: From a fragmented to an integrated approach

Ari Cowan, Co‐director of the CAN International Institute, Bellevue, WA

The violence integrative prevention and restoration model: A demonstrated, evidence‐based, and effective approach for preventing violence in healthcare settings

Paper session 7: Consequences of workplace violence

Tracy Whitaker, Director of the Center for Workforce Studies, National Association of Social Workers, Washington, DC

I can’t believe this is happening: Social workers “responses to workplace bullying”

Melissa Taylor, TriHealth, Cincinnati, OH

The reciprocal influence between nurse burnout and patient violence

Christina Purpora, Assistant Professor, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA

Horizontal violence and its relationship to quality of care

The two highest ranked paper abstracts based on the double‐blind peer review process were selected for Best Paper Abstract and Paper Abstract Honorable Mention. The Best Paper Abstract was awarded to Judith Arnetz for her presentation Using Database Reports to Reduce Workplace Violence: Perceptions of Hospital Stakeholders. The Paper Abstract Honorable Mention was awarded to Adam Hill for his presentation Measureable Results: Reducing Staff Injuries on a Specialty Psychiatric Unit for Patients with Developmental Disabilities.

Poster sessions. There were 23 abstracts presented during the three poster sessions. A summary of the poster sessions is provided in Table 2.



Table 2. Poster abstracts presented during the conference.


Poster session 1: Incivility and workplace bullying

Jeanine Goodin, Associate Professor of Clinical, College of Nursing, University of Cincinnati, Cincinnati, OH

Bullying, brain structure and brain‐targeted interventions

Jacoba Leiper, Professional Studies Team, University of North Carolina at Chapel Hill, Mebane, NC

Disruptive behavior among nurses on medical surgical units: A preliminary qualitative study

Peggy Berry, Doctoral Student, College of Nursing, University of Cincinnati, Cincinnati, OH

Novice nurse coping strategies following workplace bullying

Susan Johnson, PhD Student, School of Nursing, University of Washington, Olympia, WA

Organizational and regulatory discourses of workplace bullying

Francesca Armmer, Chairperson, Nursing, Bradley University, Peoria, IL

Perceptions of horizontal violence in staff nurses and intent to leave

Purnima Gopalkrishnan, Graduate Student, Psychology, Bowling Green State University, Bowling Green, OH

Source of incivility and nurses’ safety behaviors: POS as a moderator

Sharon Stagg, Director, Shore Wellness Partners, Nursing, Shore Health System, Cambridge, MD

Survey research evaluation of a workplace bullying program

Kiefah Awadallah, Department Nurse Educator, Center for Emergency Medicine‐Adults, University Hospitals Case Medical Center, Cleveland, OH

Workplace bullying and structural empowerment: An emergency department nurses assessment

Mary Alice Melwak, Quality Specialist Mattel Children’s Hospital, Quality Management, UCLA Healthcare, Las Vegas, NV

Workplace bullying and lateral violence: A conceptual model for violence awareness and reduction




Poster session 2: Physical violence in healthcare settings

Tammy Mentzel, Research Associate, College of Nursing, University of Cincinnati, Cincinnati, OH

An intervention for reducing violence against healthcare workers

Katie Koss, Nurse Manager, Pediatric Emergency Department, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee

But they are little—Why should i be scared?

Donna Gates, Adjunct Professor, College of Nursing, University of Cincinnati, Cincinnati, OH

Evaluation of a comprehensive violence prevention program in emergency departments

Jeffrey Beers, Clinical Risk Management and Patient Safety, University Hospitals Case Medical Center, Olmsted Falls, OH

Family centered relationship based communication guide

Gina Kicos, Emergency Department, Aultman Health Foundation, Canton, OH

“Stressed out?” (Secondary traumatic stress: an educational intervention for ED RNs)

Anne Taylor, Staff Nurse, Emergency Department, LewisGale Hospital Montgomery, Blacksburg, VA

Violence in the emergency department: It is not part of the job

Lynn Schultz, Staff Nurse, Emergency Department, Grant Medical Center, Canal Winchester, OH

Violence not accepted here




Poster session 3: A review of workplace violence

Jeffrey Beers, Clinical Risk Management and Patient Safety, University Hospitals Case Medical Center, Olmsted Falls, OH

Building a critical incident management team

Gordon Gillespie, Assistant Professor, College of Nursing, University of Cincinnati, Cincinnati, OH

Environmental risks for workplace violence in Cuban healthcare settings

Jacoba Leiper, PhD Student, University of North Carolina at Chapel Hill, Mebane, NC

Horizontal violence among nurses: A review of the literature

Kathy Cook, Chief Nursing Officer, Nursing, St. Elizabeth Health Center, Youngstown, OH

Help—I working in a hostile work environment

Christian Burchill, Clinical Nurse, Emergency Nursing, University of Pennsylvania Health System, Philadelphia, PA

Results of a staff survey about workplace safety: Implications for one academic ED nursing staff

Saad Alghanim, King Saud University, Riyadh, Saudi Arabia

Violence exposure among health care professionals in the Saudi public hospitals

Shellie Scribner, Clinical Educator, Emergency Department, Grant Medical Center, Stoutsville, OH

Violence against nurses and other health care personnel in an urban Level I trauma center

During the conference, each poster was evaluated by three independent reviewers using a standard score sheet. Evaluation sheets were tabulated. The two highest ranked posters based on the peer review process were selected for Best Poster and Poster Honorable Mention. The Best Poster was awarded to Francesca Armmer for her poster Perceptions of Horizontal Violence in Staff Nurses and Intent to Leave. The Poster Honorable Mention was awarded to Shellie Scribner for her presentation Violence against Nurses and Other Health Care Personnel in an Urban Level I Trauma Center.

Panel discussion/consensus building session. On the last day of the conference, a 2 ¼ hour panel discussion/consensus building session was held. There were three expert panelists: Drs. Donna Gates, Paula Grubb, and Kenyatta Mickles. Dr. Donna Gates served as an expert for Type II workplace violence (customer‐client violence). Dr. Paula Grubb served as an expert for Type III workplace violence (employee‐employee violence). Dr. Kenyatta Mickles served as an expert for Type IV workplace violence (personal relationship violence). Dr. Mickles is an Assistant Professor of Clinical with the College of Law at the University of Cincinnati, Cincinnati, OH. This session was attended by 23 conference registrants and moderated by Dr. Gordon Gillespie (the grant PI and conference chair).



The session was audio‐recorded using a digital recorder and the recording was transcribed verbatim by a professional transcriptionist. The transcript was qualitatively analyzed to address Specific Aim 3: Analyze whether the questions raised during the University of Iowa Injury Prevention Research Center summit of 2000 have been addressed.

Description of the conference attendees. There were 84 attendees from 19 states representing nine disciplines (criminology, industrial hygiene, law, medicine, nursing, pharmacy, protective services, psychology, and social work). Evaluations were returned from 52 conference attendees. Demographic data were provided on the conference evaluation forms. The majority of conference attendees were women, Caucasian, and had a graduate degree. The mean age of conference attendees was 49.2 years with a median age of 49 years (range 32 years to 65 years). Table 3 provides a depiction of the conference attendees. Table 3. Conference attendee demographics.

Demographic Characteristic N (%)

Sex Male Female

8 (17%) 39 (83%)

Race African‐American Caucasian Other

3 (6.4%) 42 (89.4%) 2 (4.3%)

Ethnicity Hispanic Non‐Hispanic

0 (0%) 33 (100%)

Educational Attainment Associate degree Bachelor’s degree Master’s degree PhD student Clinical doctorate Doctor of Philosophy (PhD) Other/not specified

5 (11.1%) 7 (15.6%) 10 (22.2%) 12 (26.7%) 3 (6.7%) 6 (13.3%) 2 (4.4%)



Progress toward achievement of specific aims (conference objectives). 1. Discuss the current epidemiology of incivility, bullying, verbal and physical aggression, threatening

words or actions, sexual harassment, and physical assaults enacted against healthcare workers. Each conference attendee was asked to rate their agreement that the 1st conference objective was met based on a Likert rating of 1‐strongly disagree to 5‐strongly agree. The mean score for this item was 4.65 indicating that conference attendees strongly agreed that the 1st conference objective was met (see Figure 1).

Figure 1. Percentage of agreement by Likert rating categories that Conference Objective 1 was met. 2. Evaluate intervention programs aimed at preventing and reducing the incidence and sequelae of

workplace violence against healthcare workers by visitors, patients, coworkers, and intimate partners.

Each conference attendee was also asked to rate their agreement that the 2nd conference objective was met based on a Likert rating of 1‐strongly disagree to 5‐strongly agree. The mean score for this item was 4.6 indicating that conference attendees strongly agreed that the 2nd conference objective was met (see Figure 2).



Figure 2. Percentage of agreement by Likert rating categories that Conference Objective 1 was met. 3. Analyze whether the questions raised during the University of Iowa Injury Prevention Research

Center summit of 2000 have been addressed. The conference committee reviewed recommended workplace violence research agenda documented in Workplace Violence: A Report to the Nation written by the University of Iowa Injury Prevention Research Center (2001). Panel questions were then drafted and provided in advance to the three panel members (Drs. Donna Gates, Paula Grubb, and Kenyatta Mickles). Boxes for additional panel questions provided by conference attendees were placed at the conference registration desk and in the conference rooms. In total, 41 questions were prepared for the panelists. The panel discussion started with a greeting of the panel and conference attendees. Each panelist then introduced herself and area of expertise: Dr. Donna Gates for customer/client violence, Dr. Paula Grubb for coworker violence, and Dr. Kenyatta Mickles for personal relationship violence. During each panel member’s personal introduction, she also provided a brief overview as to the state of the science for her area of expertise. Next, the panel was opened for questions from the floor. Questions were asked by both the moderator (Dr. Gordon Gillespie) and the conference attendees. The panel discussion lasted approximately 135 minutes and was closed with a summary of the panel discussion. The entire panel discussion was digitally recorded. The recording was then transcribed verbatim by a professional transcriptionist.



Keep points related to the state of the science based on the panel discussion were:

(a) Great emphasis has been placed on coworker violence and violence from patients and visitors. Little to no research is focused on personal relationship violence in healthcare settings signifying a future research agenda.

(b) Workplace violence in healthcare settings is predominantly studied in the nursing population. Future research needs to address workplace violence in all disciplines including social work and psychology.

(c) A common typology for describing subgroups of violence needs to occur. For example, researchers commonly interchange terminology for incivility and bullying when there is a distinction between the two terms.

(d) There exists a gap in health policy focused on the occupational safety of employees from workplace violence. Currently, there is no evidence that strides have been made in terms of organizations voluntarily complying with or enforcing the General Duty Clause of the OSHA guidelines. Anecdotally, organizations have recently started to make changes with enforcement in terms of coworker violence; however, there is no available scientific data to reflect the impact the changes are having on the magnitude of the problem of workplace violence.

(e) There needs to be a greater emphasis and research on the financial impact of workplace violence on the worker and patient care delivery.

(f) Concerns for personal privacy and stigma will continue to limit the ability of researchers to measure and report workplace violence. As a result, underreporting will likely continue.

(g) For researchers reporting intervention effectiveness, there is not a report on sustainability. Future dissemination needs to address this key aspect of intervention studies.

(h) The state of the science reflects little progress. A likely cause of this problem is the form of dissemination primarily used: paper and poster presentations vs. manuscript development/submission to peer‐reviewed journals.

(i) Epidemiological studies are limited by the use of self‐report data. Future research needs to use triangulation methods to reduce this limitation.

(j) No studies are known related to the “recovery” of workplace violence after it does occur. Future research needs to address the interventions that are being provided to the employee victims of workplace violence.

Conclusion Workplace violence continues to be problematic for healthcare workers. Researchers continue to advance the state of the science for WPV research; however, there remain areas that require targeted research. Specific gaps in the science requiring future research include the description and tsting of interventions aiming to prevent, manage, and recover from WPV; the consequences of WPV against healthcare workers (e.g., posttraumatic stress symptoms, changes in work productivity); personal relationship violence in the workplace; and criminal‐related violence in the workplace (e.g., robbing a pharmacy). Future research also needs to target multidisciplinary populations and less focused populations such as pharmacists, social workers, and technical workers (e.g., laboratory, radiology, and pharmacy technicians). Of critical importance, researchers need to publish their findings in the peer‐reviewed literature. Publications: None



Publication Plans We have contracted with the editor of Work: A Journal of Prevention, Assessment & Rehabilitation to offer a special edition of the journal focused on workplace violence in healthcare settings. The special edition is slated for publication in late 2014. Currently, 13 paper and keynote presenters have agreed to write a full manuscript based on their presentation for the special edition of the journal. A summary of the state of the science based on the findings from the panel discussion will be included as a paper in the special edition of the journal. Inclusion of Children: None Materials Available for Other Investigators: The majority of the paper sessions and keynote presentations were audio‐recorded using Adobe Connect technology. Permission to record these sessions was provided in writing by the presenters. Sessions will be made freely available to the public from a University of Cincinnati web link.

FINAL PROGRESS REPORT Title Page PrincipalWorkplace violence (WPV) is a serious and growing problem...

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