1. Small, Tamara F. PhD, APRN, FNP-C

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Workplace violence (WPV) is recognized by both professional and regulatory agencies as an occupational hazard (American Nurse Association, 2015; Occupational Safety and Health Administration [OSHA], 2015). For home healthcare clinicians (HCCs), the patient's home and neighborhood are the "worksite," which is an unpredictable and unsupervised environment. Home visits are usually conducted blindly to violence in the neighborhood and the patient's behavioral and criminal history. A safety committee can establish policies and procedures, assess current safety concerns, and develop strategies to promote a safe and healthy workplace (Morris & Yaross, 2013). It can also devise a comprehensive WPV prevention program based on OSHA's 2015 WPV prevention guideline elements. To ensure management and employees are involved, both should serve as safety committee members. There are five elements of an effective WPV prevention program: (1) Management commitment and employee participation; (2) Worksite analysis; (3) Hazard control and prevention; (4) Safety and health training; and (5) Recordkeeping and program evaluation (OSHA, 2015).


Management commitment is demonstrated by acknowledging the value of a safe workplace, establishing policies and procedures, allocating resources, and implementing appropriate recommendations from members of the safety committee. Employee participation includes development, implementation, evaluation, and modification of a comprehensive WPV prevention program, providing input on program design, and identifying daily activities that place employees at risk for WPV (OSHA, 2015). Clinicians are best situated to describe their experiences with WPV and offer recommendations for interventions to mitigate or prevent WPV.


A worksite analysis is performed by all members of the safety committee and involves an assessment of the workplace to identify existing or potential risks (OSHA, 2015). Risk assessments are conducted on new and existing patients and neighborhoods. Also, an analysis involves assessing WPV prevention training modules, reviewing incident reports and reports of near-misses, conducting employee and patient safety surveys, providing incident debriefing sessions, and collaborating with a liaison who specializes in criminology to create crime threshold levels for the neighborhood to determine safety and security needs (Morris & Yaross, 2013; OSHA).


After the worksite analysis, the safety committee should outline the appropriate steps to mitigate or prevent identified risks (OSHA, 2015). Clinicians should complete WPV prevention training during home care orientation, annually, and when changes arise (Morris & Yaross, 2013; OSHA). A safety tip sheet and a safety reference manual for HCCs that includes home care safety policies and procedures, duress procedures, and contact information for an escort service should be developed (Morris & Yaross).


Safety and health training is essential to a comprehensive WPV prevention program and helps ensure all employees are aware of hazards (OSHA, 2015). Training modules on safely conducting a home care visit, identifying WPV in the home care setting, and procedures for seeking medical and psychological care can be developed by the safety committee (Morris & Yaross, 2013; OSHA).


Recordkeeping and evaluation are necessary to determine the overall effectiveness of a WPV prevention program (OSHA, 2015). An organized database of WPV incidents and near-misses through a centralized reporting system should be maintained. Accurate records of WPV incidents, near-misses, patient history of violence, neighborhood violence, and training can help determine the severity of WPV, identify developing trends or patterns, and develop interventions to mitigate or prevent WPV (OSHA).


WPV is one of the most complex and serious occupational hazards. There are no quick and easy solutions for preventing WPV, but a safety committee can establish a comprehensive WPV prevention program and promote a safe workplace.


Lung Development May Explain Why Some Non-Smokers Get COPD and Some Heavy Smokers Do Not

NIH: According to a new study, people with small airways relative to the size of their lungs may have a lower breathing capacity and, consequently, an increased risk for COPD-even if they don't smoke or have other risk factors. Smoking, asthma, or air pollution account for many COPD cases, but up to 30% of cases occur in people who never smoked, and only a minority of heavy smokers develop the disease, suggesting that there are other risk factors at play. Previous research offered a clue about a possible cause, finding that about half of older adults with COPD appeared to have low lung function early in life. To find out if small airways might be the culprit for COPD in people who did not smoke, the team led looked at records for more than 6,500 older adults participating in three studies that included smokers and nonsmokers with and without COPD.


The MESA Lung study, based in six U.S. cities, included white, African American, Hispanic, and Chinese American people who were age 69 on average. The participants from the CanCOLD study were age 67 on average and came from nine Canadian cities. SPIROMICS, based at 12 U.S. medical centers, included people who were age 63 on average and reported 20 or more pack-years of smoking.


Participants with smaller airways relative to lung size were much more likely to develop COPD compared with those with the larger airways relative to lung size. The association remained after considering standard COPD risk factors, including smoking, pollutants, and asthma. Never smokers with COPD had much smaller airways relative to lung size, whereas the heavy smokers who did not have COPD had larger than normal airways.




American Nurse Association. (2015). American Nurses Association position statement on incivility, bullying, and workplace violence. Accessed November 1, 2018. Retrieved from[Context Link]


Morris R. J., Yaross D. (2013). Keeping off-site employees safe. Journal of Healthcare Protection Management, 29(2), 51-61. [Context Link]


Occupational Safety and Health Administration. (2015). Guidelines for preventing workplace violence for healthcare and social service workers.[Context Link]