Home Healthcare. copyright Traci Galinsky 1. Home Care Aides 2 nd Fastest-Growing Occupation in the U.S.

Transcription

1 The United States has seven uniformed services: United States Department of Defense 1 Army (USA) 2 Navy (USN) 3 Air Force (USAF) 4 Marine Corps (USMC) United States Department of Homeland Security 5 Coast Guard (USCG) United States Department of Commerce 6 National Oceanic and Atmospheric Administration Commissioned Corps (NOAA Corps) United States Department of Health and Human Services 7 Public Health Service Commissioned Corps (PHSCC) National Conference for Workplace Violence Prevention & Management in Healthcare Settings University of Cincinnati, College of Nursing Assaults of Workers by Patients in Home Health Care May 11, 2012 Traci Galinsky, Ph.D., H. Amy Feng, M.S., & Jessica K. Streit, M.S. tgalinsky@cdc.gov The display of photos showing equipment or products in this presentation does not constitute product endorsement by CDC or NIOSH. The findings and conclusions in this presentation were determined by the authors and other researchers and do not necessarily represent the official position of CDC or NIOSH. Home Healthcare Fastest-Growing Sector of the Healthcare Industry Currently 1.7 million workers 2.5 million workers projected by 2018 Nurses, Nursing Assistants, Physical Therapists, etc., and... Home Care Aides 2 nd Fastest-Growing Occupation in the U.S. cooking, cleaning, toileting, bathing, dressing, transferring patient handling 3 4 Acknowledgments We extend sincere appreciation to Ms. Julia Limanowski for her assistance with data processing and NIOSH peer reviewers Drs. Susan Burt, Paula Grubb, and Edward Krieg. We also thank the participating agencies, the Service Employees International Union, and, especially, the HHC workers for their study participation and invaluable service. Violence is the leading concern in Home Healthcare Research (mostly) from institutional settings: Fatal and severe non-fatal violence are rare; most assaults are physically minor, but The consequences are not minor: fear anxiety depression cognitive difficulties reduced job performance reduced job satisfaction reduced job commitment refusal of care intentions to quit retaliatory violence shortened home visits 5 6 copyright Traci Galinsky 1

2 Previous studies of violence in Home Healthcare Barling et al. (2001) 3.2% kicked, bitten or hit with fist 3.5% pushed, grabbed, shoved, or slapped Geiger-Brown et al. (2007) 3.3% assaulted or threatened Sherman et al. (2008) 29.5% verbally abused or threatened Analyses of Assault Data from NIOSH Survey of Home Healthcare Workers Goals of the analyses: Quantify specifically the rate of physical assaults by patients against workers Canton et al. (2009) 58.9% verbally abused 16.3% threatened 3.3% physically assaulted Gershon et al. (2008) 7.8% felt threatened by patients Explore potential risk factors for assaults by patients by examining responses to various survey items to see if they are statistically associated with being assaulted (% of workers) 7 8 Survey Items Examined as Potential Predictors of Assault 1 or more patients with dementia*? Routinely perform 1 or more patient handling* tasks? (transfer, reposition, bathe, dress/undress, change adult diapers) Feel threatened by others in/around patients homes? Use needles on the job? Worker age*, gender, race, job title, hours worked per week *Identified as a risk factor in institutional health care settings Survey Sample Convenience sampling at 11 Home Healthcare agencies in Arkansas, California, Illinois, and Oregon Mostly in-person group sessions Some mailed surveys Response Rate: 64% Job Title n % of Sample Home Care Aide Certified Nursing Assistant Nurse N = Assault Survey Items to the best of your memory In the past 12 months, have you been hit, kicked, pinched or shoved by a home care patient? In the past 12 months, have you been bitten by a home care patient? How many times? Briefly note any injuries, lost work days, light-duty days Physical Assault Rates in... This study (Galinsky et al., 2010) 4.6% hit, kicked, pinched, shoved, or bitten Other Home Healthcare studies: Studies in Hospitals & Nursing Homes: 17-82% assaulted Barling et al. (2001) 3.2% kicked, bitten or hit with fist 3.5% pushed, grabbed, shoved, or slapped Geiger-Brown et al. (2007) 3.3% assaulted or threatened Canton et al. (2009) 3.3% physically assaulted Higher rates possibly due to larger patient populations higher frequency of new patients other factors to be discussed... (% of workers) copyright Traci Galinsky 2

3 Assaults in this study Number of workers... assaulted 1 or more times 31 = 4.6 % hit, etc. 1 or more times 29 bitten 1 or more times 2 both 0 not assaulted 646 Mode Median Mean SD Min Max # of times assaulted * * 100 assaults was atypical. The next highest # of assaults reported was 12. Statistical Analysis to Identify Factors Predictive of Assaults Multivariate Logistic Regression Outcome Variable: Assaulted vs. Not Assaulted Predictor Variables: 1 or more patients with dementia? Routinely perform 1 or more patient handling tasks? Feel threatened by others in/around patients homes? Use needles on the job? Worker age Worker gender Worker race Hours worked per week Statistical Analysis to Identify Factors Predictive of Assaults Multivariate Logistic Regression Outcome Variable: Assaulted vs. Not Assaulted Predictor Variables: 1 or more patients with dementia? Routinely perform 1 or more patient handling tasks? Feel threatened by others in/around patients homes? Use needles on the job? Worker age Worker gender Worker race Hours worked per week % Workers Assaulted Statistically Significant Predictors of Assaults /250 14/117 Any Dementia Patients? OR=4.3 95% CI No 2/304 29/373 Yes Routine Patient Handling? OR= % CI /597 10/69 Felt Threatened by Others? OR= % CI Discussion of Significant Risk Factors Patients with Dementia Home Healthcare workers interviewed in focus groups reported feeling that dementia patients were less likely to be assaultive in their own familiar home surroundings (Fitzwater & Gates, 2000). Results of the current study suggest home care workers should not underestimate patient dementia as a risk factor. Patient dementia may also contribute to more severe assaults and more frequent assaults... In homes and in healthcare facilities. Discussion of Significant Risk Factors Patient Handling... Is also more common in healthcare facilities, which may contribute to higher assault rates in those settings. In this study: 55% of workers handled patients 29 of the 31 assaulted workers were patient handlers copyright Traci Galinsky 3

4 Discussion of Significant Risk Factors Perceived Threats of Violence from Others Dangerous neighborhoods...? Culture of violence...? Climate of fear...? Analyses of Data from NIOSH Survey of Home Healthcare Workers Additional Goals of the analyses: Determine if workers shortened home visits due to concerns for their safety (e.g., Fazzone et al., 2000; Kendra et al., 1996) Examine assaults and perceived threats of violence as potential predictors of shortening home visits Shortened Visits 30 No Yes 25 % Reporting Shortened Visits /637 7/31 29/593 14/68 What about interventions? 0 Assaulted? Felt Threatened by Others? 2 (1)=14.07, p < (1)=24.72, p < ERGONOMICS Ergonomics in Patient Care Eliminate or reduce forceful exertions and awkward postures Enhances safety for workers and patients Design all components of the work environment... Furniture Equipment Tools Tasks... to best accommodate the capabilities of the worker. Assistive Devices A few examples: Hoists/Lifts Lateral Transfer Aids Fast-Raising Beds Triangle Bars Gait Belts/Slings Slide Boards Lift Chairs Swivel Disks Grab Bars Raised Toilets Shower/Toilet Chairs Portable Bathing Units copyright Traci Galinsky 4

5 Bariatric Hoist Ceiling Hoist Photo copyright by SureHands Lift & Care Systems. Reprinted with permission Patient Handling Sling Lateral Transfer Aide or Slide Sheet Photo copyright by SureHands Lift & Care Systems. Reprinted with permission. Photo copyright by SureHands Lift & Care Systems. Reprinted with permission Air-assisted Lateral Transfer Aide Shower/Toileting Chair Photo copyright by Sammons Preston Rolyan. Reprinted with permission copyright Traci Galinsky 5

6 Air-assisted Vertical Lift and Lateral Transfer Ergonomics Interventions for Patient Handling Numerous studies have demonstrated positive effects: Photo courtesy of Hovertech Hignett (2003 cites 16 studies from ) Spiegel et al. (2002) Evanoff et al. (2003) Collins et al. (2004) Chhokar et al. (2005) Engst et al. (2005) Fujishiro et al. (2005) Santaguida et al. (2005) Nelson et al. (2006, 2008) Effectiveness of Ergonomics Interventions for Patient Handling: Significant reductions (30-95%) in: Injuries Lost Work Time Spinal Loads Harmful Postures Perceived Exertion Staffing Requirements and Assaults by Patients (Collins et al., 2004): Data from 6 nursing homes showing 30% -- 72% reductions in patient-on-worker assaults Suggestions for Further Research All healthcare settings hospitals, nursing homes, home healthcare... Evaluate the impact of ergonomic patient handling interventions on patient violence Home healthcare... promote and evaluate the use of ergonomic patient handling interventions... for reducing overexertion in workers and violence from patients References and Suggested Reading Bureau of Labor Statistics (2007). Table R8. Incidence rates for nonfatal occupational injuries and illness involving days away from work per 10,000 full-time workers by industry and selected events or exposures leading to injury or illness. Retrieved May 10th, 2009 from Chhokar, R., Engst, C., Miller, A., Robinson, D., Tate, R., and Yassi, A. (2005). The three-year economic benefits of a ceiling lift intervention aimed to reduce healthcare worker injuries. Applied Ergonomics, 36, Collins, J.W., Wolf, L., Bell, J., and Evanoff, B. (2004). An evaluation of a best practices musculoskeletal injury prevention program in nursing homes, Injury Prevention, 10, Engst, C., Chhokar, R., Miller, A., Tate, R., and Yassi, A. (2005). Effectiveness of overhead lifting devices in reducing the risk of injury to care staff in extended care facilities. Ergonomics, 48, Evanoff, B., Wolf, L., Aton, E., Canos, J., and Collins, J. (2003). Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace. American Journal of Industrial Medicine, 44, Fujishiro, K., Weaver, J., Heaney, C., Hamrick, C., and Marras, W. (2005). The effect of ergonomic interventions in healthcare facilities on musculoskeletal disorders. American Journal of Industrial Medicine, 48, Galinsky, T., Feng, H.A., Streit, J., Brightwell, S., Pierson, K., Parsons, K., and Proctor, C. (2010). Risk factors associated with patient assaults of home healthcare workers. Rehabilitation Nursing Journal, 35, Galinsky, T., Hudock, S., and Streit, J. (2010). Addressing the need for research on bariatric patient handling. Rehabilitation Nursing Journal, 35, Galinsky, T., Waters, T., and Malit, B. (2001). Overexertion Injuries in Home Health Care Workers and the Need for Ergonomics. Home Health Care Services Quarterly, 20, Gallagher, S. (1997). Morbid obesity: A chronic disease with an impact on wounds and related problems. Ostomy Wound Management, 43, Head, M., and Levick, P. (1996). Patient handling: an ergonomic intervention. In: Proceedings of the 32nd Annual Ergonomics Society of Australia and the Safety Institute of Australia National Conference, Enhancing Human Performance, September22-25, Canberra, Australia. Hignett, S. (2003). Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review. Occupational and Environmental Medicine, 60 (e6). Available at Accessed 12/21/2007. Marras, W., Davis, K., Kirking, B., and Bertsche, P. (1999). A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques. Ergonomics, 42(7), Muir, M. and Heese, G. (2008). Safe patient handling of the bariatric patient: Sharing of experiences and practical tips when using bariatric algorithms. Bariatric Nursing and Surgical Patient Care, 3(2), Obesity Action Coalition (2007). Facts and figures. Retrieved November 29th, 2007 from Nelson, A. et al. (2001 revised 2005). Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Accessed on May 13th, 2009 from the internet at Nelson, A., Collins, J., Siddharthen, K., Matz, M., and Waters, T. (2008). Link between safe patient handling and patient outcomes in long-term care. Rehabilitation Nursing, 33, copyright Traci Galinsky 6

7 Nelson, A., Harwood, K., Tracey, C., and Dunn, K. (2008). Myths and facts about safe patient handling in rehabilitation. Rehabilitation Nursing, 33, Nelson, A., Matz, M., Chen, F., Siddharthan, K., Lloyd, J., and Fragala, G. (2006). Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International Journal of Nursing Studies, 43, Nelson, A., Waters, T., Menzel, N., Hughes, N., Hagan, P., Powell-Cope, G., Sedlak, C., and Thompson, V. (2007). Effectiveness of an evidence-based curriculum module in nursing schools targeting safe patient handling and movement. International Journal of Nursing Education Scholarship, 4, NIOSH (2006). by Collins, J.W., Nelson, A., & Sublet, V. Safe Lifting and Movement of Nursing Home Residents. DHHS (NIOSH) Publication No NIOSH (2010). NIOSH Hazard Review: Occupational Hazards in Home Healthcare. DHHS (NIOSH) Publication No Nyran, P. (1991). Cost effectiveness of core-group training. In: W. Karwowski and J. Yates (Eds), Advances in Industrial Ergonomics and Safety III, Taylor & Francis: Parsons, K., Galinsky, T.L., and Waters, T. (2006b). Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 2: Lift and transfer assistance for non weight-bearing home care patients. Home Healthcare Nurse, 24, Santaguida, P., Pierrynowski, M., Goldsmith, C., and Fernie, G. (2005). Comparison of cumulative low back loads of caregivers when transferring patients using overhead and floor mechanical lifting devices. Clinical Biomechanics, 20, Spiegel, J., Yassi, A., Ronald, L., Tate, R., Hacking, P., and Colby, T. (2002). Implementing a resident lifting system in an extended care hospital: Demonstrating cost-benefit. American Association of Occupational Health Nurses, 50, Waters, T. (2007). When is it safe to manually lift a patient? American Journal of Nursing, 107, Waters, T., Collins, J., Galinsky, T.L., and Caruso, C. (2006). NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry. Orthopaedic Nursing, 25, Orr, G. (1997). Ergonomics programs for health care organizations. In M.A. McDiarmid and E.R. Kessler (Eds.) The Health Care Worker, Occupational Medicine State of the Art Reviews, 12 (4), , Hanley and Belfus: Philadelphia. Parsons, K., Galinsky, T.L., and Waters, T. (2006a). Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 1: Lift and transfer assistance for partially weight-bearing home care patients. Home Healthcare Nurse, 24, Thank You! Traci Traci Galinsky, Ph.D. CAPT, U.S.P.H.S. National Institute for Occupational Safety and Health (NIOSH) 4676 Columbia Parkway Mail Stop C-24 Cincinnati, OH tgalinsky@cdc.gov 39 copyright Traci Galinsky 7