DNP, Kent State University, 2024, College of Nursing

Lateral violence (LV) in healthcare remains a critical issue, impacting both staff well-being and patient care quality. This quality improvement (QI) project aimed to raise awareness of LV and provide practical strategies for healthcare professionals to address it effectively. Educational sessions were developed to define LV, explore its causes and consequences, and teach Cognitive Rehearsal (CR) techniques to combat LV. The project also emphasized organizational policy reviews, scenario-based learning, and promoting a culture of safety through continuing education. The QI initiative was conducted in a 269-bed acute care hospital, with two educational sessions held: one virtual session open to all hospital employees and an in-person session with the Nursing Practice Council. In total, 33 healthcare professionals attended the sessions. Participants were provided with educational materials, including an infographic and a pocket card summarizing LV concepts and CR responses. Data collection involved interactive polls and post-session evaluations, with results indicating 70% of participants had experienced LV and 91% reported feeling more knowledgeable about its impact. Participants expressed increased confidence in recognizing and addressing LV, with 73% rating the sessions as excellent. The project's findings highlight the value of combining educational interventions with policy reinforcement to promote awareness and improve responses to LV in healthcare. Limitations of the project include small sample size, limited post-session feedback, and the short-term nature of follow-up, all of which restrict the ability to assess the long-term impact of the intervention. Despite these limitations, this project has demonstrated positive results in enhancing awareness and offering practical strategies to address LV. Future initiatives could expand participation, include long-term assessments, and incorporate simulation exercises to further strengthen staff competency in (open full item for complete abstract)

Committee: Denise Pacholski DNP, APRN, NP-C (Committee Chair); Tracey Motter DNP, RN (Committee Member); Karen Mascolo DNP, RN (Committee Member) Subjects: Health Care; Nursing

Doctor of Philosophy, The Ohio State University, 2019, Social Work

Women who endure intimate partner violence (IPV) are likely to experience employment instability or loss of paid work time and unemployment as a result of their abuse. When women who experience IPV, particularly those who are mothers, are impacted by employment instability they may become financially dependent on abusive partners. The current convergent mixed-methods dissertation investigated the longitudinal relationship between intimate partner violence, the unique workplace experiences of survivors, and three forms of survivors' employment instability using a convergent mixed methods design. Using a latent growth curve model, the current study investigated the impact of IPV on mothers' employment trajectories in the Fragile Families and Child Wellbeing (FFCW) study over the span of eight years. Three outcomes of employment were selected for the analysis based on their use in previous literature: hours worked per week, annual weeks worked, and employment status. Unconditional growth curve models revealed that all outcomes had significant variation at time one between individuals' employment as well as a significant increase in employment over time. Conditional growth curve models revealed a significant effect of IPV on time two annual weeks worked as well as employment status, indicating that mothers were most likely to experience employment instability when they had a three-year-old child. The conditional model for employment status also revealed that IPV at time two has a six year lagged effect on employment status. Interviews with individual survivors of IPV were also conducted for this study in a large Midwestern city. Participants receiving services at a partner agency were interviewed about their experiences of employment instability, workplace disruptions (including with technology), and their perceptions of policy and practices that employers use to support employees experiencing abuse. Findings revealed that survivors suffered a range of employment (open full item for complete abstract)

Committee: Kathryn Maguire Jack (Committee Chair); Susan Yoon (Committee Member); Njeri Kagatho (Committee Member); Sharvari Karandikar (Committee Member) Subjects: Social Work; Womens Studies

PhD, University of Cincinnati, 2012, Nursing: Nursing - Doctoral Program

One setting where violence exposure among adolescents may occur, yet has received little attention, is the workplace. With nearly six million U.S. adolescents age 16-19 employed, researchers need to understand from the adolescent employee viewpoint any perceived safety risks from violence so appropriate interventions can be developed. Purpose: The specific aims of the study were to (a) explore adolescent employees' perceptions of safety as it relates to WPV and (b) describe how adolescent employees' perceptions of safety affect stress, anxiety, and productivity while at work. Methods: A qualitative dominant mixed methods design was used to analyze data from a convenience sample of adolescents employed by a retail chain of ice cream stores in one Midwestern city. Surveys and individual interviews were conducted to study adolescent employees' perceptions of safety as it relates to WPV. Analysis consisted of simple descriptive statistics (survey data), conventional content analysis (interview data), and mixed analysis using data displays to reanalyze qualitative themes for differences based on variables of WPV exposure and gender. Results: Thirty non-Hispanic Caucasian adolescents (20 females, 10 males) ages 16-18 comprised the sample. Fifty percent (n = 15) reported WPV exposure and 40% (n = 12) received WPV training in their current job. Participants expressed positive and mixed perceptions of safety as it relates to WPV. Most participants recalled experiencing negative stress responses after exposure to WPV and half felt their ability to work was impacted. Environmental factors and presence of others in the workplace informed perceptions of safety. Nearly all male participants (90%; n = 9) reported positive perceptions of safety compared with 60% (n = 12) of females. Nearly all participants desired further WPV education and training though a few males expressed “everything is fine.” Proposed responses to future WPV varied based on the relationship with the perpe (open full item for complete abstract)

Committee: Gordon Gillespie Ph.D. (Committee Chair); Theresa Beery Ph.D. (Committee Member); Bonnie Sue Fisher Ph.D. (Committee Member); Donna Gates Ed.D., R.N., F.A.A.N. (Committee Member) Subjects: Nursing

Doctor of Philosophy, University of Toledo, 2023, Counselor Education

Workplace violence (WPV) is a national and global concern. In the United States, individuals who work in the healthcare industries are at a greater risk of experiencing WPV, and the number of injuries associated with WPV is rising. Data indicates that not all incidents of WPV are properly reported. Research suggests that the impact of WPV includes not only physical injury but also physiological and psychological harm. In addition, clinicians who are new to the professions are at greatest risk of experiencing WPV. Although many other human service professions, such as nursing, psychology, and social work, have studied WPV to increase awareness and inform prevention and response strategies, there has been limited understanding of WPV, specifically client-initiated, in the counseling profession. In 2022, Kempf et al. conducted a study and surveyed over 2,600 counselors licensed in 12 states and found that 51.1% of participants indicated that they had experienced client-initiated WPV after reading the Occupational Health and Safety Administration's definition of WPV, and 79.3% of participants indicated that they had experienced client-initiated WPV after they reviewed a list of the different types of WPV. This secondary analysis of the Kempf et al. (2022) data examined the prevalence of WPV among early career counselors using descriptive statistics and a McNemar test and found that 38.7% of participants reported experiencing client-initiated WPV after reading the OSHA definition of WPV. The number increased to 74.3% of participants after they reviewed a list of specific types of client-initiated WPV. This was found to be statistically significant. Chi-square analyses were utilized to determine if 1) there was a relationship between the type of client-initiated WPV and the setting where the client initiated WPV took place and 2) the perceived impact of the WPV on early career counselors. The findings indicated client-initiated WPV occurs in every setting where counselors (open full item for complete abstract)

Committee: John Laux (Committee Chair); Christine Fox (Committee Member); Susan Long (Committee Member); Jared Rose (Committee Member) Subjects: Counseling Education

Doctor of Philosophy, Case Western Reserve University, 2021, Management

This research explores difficult decisions by victims to report an incident of workplace violence, and difficult audit scope decisions made by auditors. It includes a qualitative study revealing the role of fear in reporting incidents of workplace violence, showing fear can deter individuals from doing the right thing, and the financial auditors' scope of testing of information technology (IT) in an integrated audit. The notion of fear in the workplace was further studied with an experimental design to measure the auditors' assessment of scope for testing when facing complex IT environments with highly skilled and hostile client teams, and a third experimental design exploring how systems thinking can be an intervention. The findings indicate that less experienced and younger individuals are more prone to fear due to seniority and authority gaps. Such fear may deter them from reporting workplace violence when they are victims or witnesses. Similarly, fear causes unskilled auditors to perform less testing on IT controls and components despite common logic and guidelines from auditing standards when faced with highly complex IT environments. The findings also reveal that systems thinking can be an intervention to counter, or in certain cases, reverse, such an effect. When provided during the auditor's audit scope planning phase, systems thinking training causes auditors to perform the same or greater level of IT testing in a complex IT environment compared to non-systems thinking, or “reductionist thinking” auditors. When used appropriately, systems thinking skills can enhance an auditor's judgment in complex situations. This implies that systems thinking can be applied to other complex audit situations.

Committee: Anthony C. Bucaro (Committee Chair); Richard J. Boland Jr. (Committee Member); Philip A. Cola (Committee Member); James E. Gaskin (Committee Member) Subjects: Accounting; Information Technology; Management; Organizational Behavior

PhD, University of Cincinnati, 2020, Nursing: Nursing - Doctoral Program

Introduction: HHCWs are at increased risk for WPV due to working alone in unsupervised, unpredictable, and potentially dangerous work environments. Similar to healthcare workers employed in institutionalized settings, HHCWs primarily experience Type II, verbal abuse from patients. Little is known about how HHCWs promote personal safety while at work. Guided by Haddon's Matrix, the purpose of this manuscript option dissertation was to estimate WPV exposures and identify interventions and resources used by HHCWs to promote personal safety and mitigate and prevent WPV. For this manuscript option dissertation, there are three distinct projects, all related to HHCWs and exposure to WPV. Methods: For project one, Whittemore and Knafl's (2005) methodology was used to conduct the integrative review. Project two used a cross-sectional design to describe the work environment of HHCWs and their WPV prevention training and resources. Data were analyzed using frequencies and percentages. Project three used a cross-sectional design to describe WPV incidents and the reporting behaviors of HHCWs. Data were analyzed using frequencies, percentages, means, and SD. Results: In project one, interventions and resources were identified for HHCWs. WPV prevention training was found to be an effective intervention for mitigating WPV incidents and increasing HHCWs confidence and knowledge about WPV. In project two, HHCWs identified WPV prevention training and resources promoting personal safety. A cell phone was primarily used but was infrequently provided by the agency. An escort or buddy system was rarely used by HHCWs. Not all HHCWs are provided WPV prevention training and resources, and training content is inadequate. In project three, the majority of WPV experienced by HHCWs was Type II, verbal abuse when the vector is the patient or the patient's family member and Type IV, iii physical assault when the vector is an intimate partner. HHCWs who experienced Type II and Type IV W (open full item for complete abstract)

Committee: Gordon Gillespie Ph.D. (Committee Chair); Kermit Davis Ph.D. (Committee Member); Scott Hutton Ph.D. (Committee Member); Carolyn Smith Ph.D. (Committee Member) Subjects: Nursing

Doctor of Nursing Practice, Mount St. Joseph University , 2020, Department of Nursing

Hospital medical surgical units are experiencing an increase in aggression from patients resulting in increased injuries to health care team members nationally and locally. On one local medical surgical unit, incident reports were made on 10 violent patient occurrences within a two year time period. Leadership recognized the need to provide team members education for mitigating aggressive behaviors. A literature review was conducted to examine interventions effective in managing aggressive or disruptive patients. Effective communication techniques and mitigation strategies have been demonstrated to decrease patient aggression, increase team member confidence levels in managing patient aggression, and to decrease team member injuries. The DNP project focused on four voluntary education sessions in a week period on a local medical surgical unit to teach team members on de-escalation techniques, therapeutic communication, mindful awareness, dementia care tips, and knowing when to exit. A confidence scale instrument was used before the education, immediately after the education, and 30 days post education. In addition, injuries to health care team members from patients was reviewed and analyzed from before and after the project to measure effectiveness of the education sessions. The results of the DNP project did support the evidence that education classes on mitigating disruptive patient behaviors increased team members' confidence level scores immediately after the education and the confidence level scores sustained in 30 days. The team member injuries from patients also decreased. The findings indicate a need to educate other medical surgical units, and to further disseminate through national conferences.

Committee: Nancy Hinzman Dr (Advisor) Subjects: Nursing

Doctor of Nursing Practice, Mount St. Joseph University , 2020, Department of Nursing

Executive Summary Workplace violence has become a priority safety concern in health care settings today. Health care providers are exposed to workplace violence more than any other profession. Statistically, 50% of all health care providers have experienced verbal aggression and 25% have been physically assaulted by an aggressive patient. Exposure to patient aggression is associated with major consequences to hospitals and patients through increased injury, loss of productivity, psychological distress, medical costs, reduced job satisfaction, and higher turnover rates. Several studies have been conducted to determine the most effective interventions for managing patient aggression within the hospital setting. Evidence strongly supports de- escalation as the first-line intervention to reduce patient aggression directed toward health care providers. While de-escalation techniques have been shown to be effective in managing violent incidents, most studies on patient aggression have only evaluated its impact in psychiatric and emergency care settings. Due to challenges associated with the costs of training and time constraints, this DNP project focused on educating registered nurses (RNs) about de-escalation techniques in order to safely manage patient aggression on the renal unit at a large metropolitan hospital in Cincinnati, Ohio between September 5, 2019 and December 2, 2019. The findings of this DNP project supported the empirical evidence showing that an educational intervention on a medical-surgical unit can result in increased competence in nurses applying de-escalation strategies in clinical practice, leading to reduced aggressive events and better health outcomes. Evidence suggests that dissemination of this project's results and a trial of the educational intervention on other medical-surgical units would be beneficial. Further, sustainability can be promoted through providing annual de-escalation education to staff. Plans for future dissemination in (open full item for complete abstract)

Committee: Laura Valle DNP (Advisor) Subjects: Nursing

PhD, University of Cincinnati, 2008, Nursing : Nursing, Doctoral Program

Workplace violence (WPV) in the healthcare setting occurs four times more often than in all private-sector industries combined; however, only one previous study included findings that violence occurs in a pediatric emergency department (PED). The purpose of this qualitative study was to identify the extent that WPV by patients and visitors occurred in an urban PED and the negative effects on PED workers. The conceptual model for this study was the workplace violence model. The research questions were related to describing the context of WPV; person, workplace, and community/environmental factors for WPV; consequences for workers, perpetrators of violence, patients, and the healthcare employer following WPV; and potential interventions to reduce the incidence and negative consequences of WPV. Interviews with 31 PED workers were audiotaped and transcribed verbatim. A modified form of constant comparative analysis was used to analyze the data. Triangulation of interview data was performed using non-participant observations and a review of medical center policies and continuing education offerings. The study results indicate that physical violence was primarily perpetrated by psychiatric patients; whereas, verbal violence was primarily perpetrated by patients' family members. Consequences reported by participants included worker stress and injury, patients being restrained, parental eviction from the ED, delays in patient care, and perceived negative image of the medical center by parents and visitors. Interventions posed were de-escalation training, early recognition and intervention for WPV, and creation of a specialized psychiatric PED. Study findings indicate that all patients and visitors should be treated as though they have the potential to be violent. Employees need to participate in education to learn how violence affects patient care, the importance of calling for help when violence occurs, and strategies to prevent violence. Employers need to recognize the ef (open full item for complete abstract)

Committee: Donna M. Gates EdD (Committee Chair); Margaret Miller EdD (Committee Member); Patricia Kunz Howard PhD (Committee Member) Subjects: Health Care; Mental Health; Nursing; Occupational Safety

PhD, University of Cincinnati, 2008, Nursing : Nursing, Doctoral Program

Workplace incivility is low-level deviant behavior with ambiguous intent to harm the target in violation of workplace norms (Andersson and Pearson 1999). Research has demonstrated that workplace incivility is associated with decreased productivity and negative health outcomes, but more information is needed about the underlying causes before interventions can be developed and tested. No research was found evaluating whether the level of workplace incivility has a single cause or multiple causes. If multi-causal, the level of incivility should fluctuate over time, whereas if it has a single cause, the level should remain stable until that cause is modified. The primary aim of this longitudinal study was to assess whether the level of workplace incivility fluctuated over time in a hospital setting. A secondary aim was to determine if demographic and employment characteristics were related to the level of incivility. Seventy-one randomly selected employees consented to participate and 85% (n=60) returned the Demographic/ Employment survey at baseline. Ninety percent of these participants were female, and 85% were Caucasian. The mean years of education were 13.86. The Incivility in Healthcare Survey (IHS) which consist of five scales measuring incivility from environmental, coworker, manager, physician, and patient sources and was distributed every month for 12 months to the participants. Women and younger employees reported significantly higher levels of incivility; whereas, those occupations reporting the lowest levels of incivility were the physicians and maintenance workers. A repeated measure ANOVA model indicated, while there was not significant fluctuations in the overall level of workplace incivility over 12 months (F=3.16 p<.0763), there were significant fluctuations in the level of workplace incivility from the coworker (F= 8.50 p=.0037) and environmental (F=5.70 p=.0174) sources. These differences in the findings regarding fluctuations over time may have been (open full item for complete abstract)

Committee: Donna Gates EdD (Committee Chair); Sue Davis PhD (Committee Member); Paul Succop PhD (Committee Member) Subjects: Organizational Behavior