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Groups in Addictions Treatment Centers: Staff Perceptions of Environmental Design and Risk for Violence
Source publication
Federal policy recommends environmental strategies as part of a comprehensive workplace violence program in healthcare and social services. The purpose of this project was to contribute specific, evidence-based guidance to the healthcare and social services employer communities regarding the use of environmental design to prevent violence.
A retros...
Context in source publication
Citations
... 4 Another study emphasised that the nursing station's design and position in relation to the dayroom facilitated patient-staff interactions and observations, though the study did not delve into specifics of the design type. 31 Further resonating with the theme, two other studies delved into the benefits and limitations of centrally located nursing stations for staff. First, in one study, a central location of the unit office was associated with a perceived decrease in safety risks among staff, attributing it to a more expansive corridor view. ...
... 41 Another study indicated that even minor issues, such as faulty phones for service users, could lead to significant operational disruptions and tension at nursing stations when service users needed to use the phone there. 31 ...
... 21 31 41 One highlighted potential safety risks associated with certain furniture choices, with staff raising concerns about furniture being potentially used as weapons or to hide contraband. 31 Expanding on this notion, the issue of insufficient seating options, particularly easy chairs relative to the patient count, was identified as a barrier to effective group activities, leading to additional challenges and frustrations for staff aiming to provide the best care. 21 These findings are supported by a cross-sectional study that identified an association between inadequate workplace furniture and staff's self-reported severe risk of illness. ...
Objectives
Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff.
Design
A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute’s critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors.
Results
In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors.
Conclusion
Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs.
PROSPERO registration number
CRD42022368155.
... A piece of furniture's robustness under unexpected loads and ability to maintain shape under climbing are usually important to keep children safe [22]-especially when designing with rigid panels. Additionally, designing to avoid pinch points during actuation and use is essential to any product a child will interact with [23]. Finally, in the case where non-rigid panels are preferable-non-rigid panels are important in furniture to help the user avoid discomfort [24]-the hinge's ability to attach to these non-rigid panels is also essential. ...
Origami-inspired design principles — including thickness accommodation techniques, surrogate folds, and a rare use of nonrigid panels — are applied here in a novel foldable furniture item known as the Hidey Cube for use in a daycare facility. Each of the design principles is applied to develop the Hidey Cube and to help it meet its design objectives, including first: the need to provide a safe space for children, and second: the desire for this safe space to be collapsible, transportable, risk-free, and play-enhancing. Through analysis and consideration of a variety of hinges commonly used in origami-based design, and by undergoing an iterative process, two variations on the Hidey Cube design are presented. These two variations — a wood composite version and a fabric-covered foam version — are described and demonstrated. The advantages and disadvantages of each design are enumerated. The fabric-covered foam version utilizes non-rigid panels in conjunction with membrane hinges, which requires an interesting upholstery-based manufacturing approach to allow for the desired actuation while limiting undesired parasitic motion, also presented here. Non-rigid panels are demonstrated to be viable for use in origami-inspired applications, and specific potential applications and recommended future work are discussed. In applications where some parasitic motion is allowable and where non-rigid panels present other functional benefit — such as in furniture, shrouds for use over a medical device, or in wearable technology — the techniques presented here are particularly beneficial.
... For example, there is ample research that has linked heavy workloads, low and inappropriate mix of staffing levels, and long wait-times with violence between patients and towards professionals [1,19,21,35]. Further, the healthcare environment, including inappropriate temperatures, confined spaces, excessive noise, overcrowding, patients' lack of privacy, noise pollution, and aesthetic deprivation have also been identified as contributing factors to aggression [34,[36][37][38]. It is our argument that prevention efforts, including the development and implementation of new technologies, should thus be reoriented to address these and other structural factors. ...
Background
There is growing public policy and research interest in the development and use of various technologies for managing violence in healthcare settings to protect the health and well-being of patients and workers. However, little research exists on the impact of technologies on violence prevention, and in particular in the context of rehabilitation settings. Our study addresses this gap by exploring the perceptions and experiences of rehabilitation professionals regarding how technologies are used (or not) for violence prevention, and their perceptions regarding their efficacy and impact.
Methods
This was a descriptive qualitative study with 10 diverse professionals (e.g., physical therapy, occupational therapy, recreation therapy, nursing) who worked across inpatient and outpatient settings in one rehabilitation hospital. Data collection consisted of semi-structured interviews with all participants. A conventional approach to content analysis was used to identify key themes.
Results
We found that participants used three types of technologies for violence prevention: an electronic patient flagging system, fixed and portable emergency alarms, and cameras. All of these were perceived by participants as being largely ineffective for violence prevention due to poor design features, malfunction, limited resources, and incompatibility with the culture of care. Our analysis further suggests that professionals’ perception that these technologies would not prevent violence may be linked to their focus on individual patients, with a corresponding lack of attention to structural factors, including the culture of care and the organizational and physical environment.
Conclusions
Our findings suggest an urgent need for greater consideration of structural factors in efforts to develop effective interventions for violence prevention in rehabilitation settings, including the design and implementation of new technologies.
... Various studies have attempted to research this aspect to gather evidence of environmental design contribution to safe environments. The study by McPhaul K. et al. (2008) conducted an environmental evaluation of healthcare facilities and used CPTED as an approach to categorise the risk factors. The study revealed aspects like visual connection, accessibility, and security affect the feeling of safety in these environments. ...
There has been an alarming rise in assaults on doctors in the last few years. Violence, as we know it, is no longer restricted to the dark streets but has entered the portals of environments considered as healing. An environment that was once considered safe has no longer remained so, especially for healthcare providers. Healthcare environments are symbols of society as they are designed through discussion amongst various actors bringing in their own set of priorities. For the designers, it symbolizes an edifice for healthcare delivery, whereas the healthcare providers look at it as a place of healing. Various studies have looked at the measures to reduce this conflict in terms of management and awareness creation but few studies have tried to understand this through the perspective of spatial and environmental design. There has been strong empirical evidence though, which shows the influence of design attributes on the users’ well-being in healthcare environments. This study was aimed at understanding the effect of various spatial attributes on the healthcare providers’ feeling of comfort in the healthcare environment. The study was conducted through qualitative interviews with healthcare providers in which a recurring theme with respect to space characteristics that emerged was regarding the doctor-patient conflicts and the sense of insecurity that it gave rise to and the contribution of design to the same. This was then further explored to understand the concepts of privacy and visibility with space syntax analysis. The findings identified the environmental attributes and spatial configurations that could help to reduce the sense of insecurity amongst healthcare providers.
... Many environmental factors, including access control, surveillance (natural and mechanical), visitor reception design, and levels of observation, can influence the measure of security in healthcare facilities (Carmel-Gilfilen, 2011;Feldbauer et al., 2008;Halpern et al., 2012;Gharaveis et al., 2018;McPhaul et al., 2008;MohammadiGorji Bosch et al., 2021). Physical design is considered one of the factors in managing ED security issues (Angland et al., 2014;Connellan et al., 2013;Gharaveis et al., 2018;Pati et al., 2014;Pati et al., 2016;McPhaul et al., 2008). ...
... Many environmental factors, including access control, surveillance (natural and mechanical), visitor reception design, and levels of observation, can influence the measure of security in healthcare facilities (Carmel-Gilfilen, 2011;Feldbauer et al., 2008;Halpern et al., 2012;Gharaveis et al., 2018;McPhaul et al., 2008;MohammadiGorji Bosch et al., 2021). Physical design is considered one of the factors in managing ED security issues (Angland et al., 2014;Connellan et al., 2013;Gharaveis et al., 2018;Pati et al., 2014;Pati et al., 2016;McPhaul et al., 2008). This study defines security as the protection of people and property, as a subset of safety in healthcare delivery. ...
... The collected data supported the findings of Anderson et al. (2010) regarding the vulnerability of nurses in EDs. Additionally, this study contributes to the body of existing literature regarding environmental design strategies to reduce aggression in hospitals (e.g., Angland et al., 2014;McPhaul et al., 2008;Pati et al., 2014;Pati et al., 2016;Poyner & Fawcett, 1995). ...
Unlabelled:
This research explored the relationship between visibility and the level of security risks as perceived by nurses and physicians in emergency departments (EDs). Security in EDs has been reported as a major global concern, and visibility has been identified as a design factor impacting behavior. However, few previous studies have rigorously investigated the role of visibility in reduction of ED security risks with evidence-based design approach. There is a lot of significant questions about how visibility impacts the reduction of security issues in EDs.
Methods:
How visibility may influence ED security was explored via qualitative methods in five EDs using semi-structured one-on-one interviews with 17 clinical staff and 48 hr of field observations. The coding process for both interviews and observational notes followed the principles of naturalistic inquiry.
Results:
The findings suggest security risks can be decreased by improving visibility. Medical staff (registered nurses and physicians) felt more secure in the EDs with higher visibility.
Discussion:
This study provides a framework to identify preferable levels of visibility in EDs and proposes design strategies to minimize security issues. Registered nurses and physicians can improve their team's sense of security by considering visibility throughout their daily practices.
... This progression over time is also observed in the literature. Although there are studies from 1990 to 2008 (Balloch et al., 1998;McPhaul et al., 2008;Winstanley & Hales, 2008), the research intensifies from 2010 onwards Lamothe et al., 2018;Sousa et al., 2014;Truter & Fouché, 2019). ...
Violence in the workplace has important consequences for workers and their own environment. Health and social services professionals are high-risk professional groups. This research has a main aim to identify the studies on client violence towards the social worker in Spain. This aim has four specific objectives to understand the phenomenon: (1) to identify those investigations that study the violence of clients against social workers; (2) to analyze the descriptive characteristics of the selected studies; (3) to analyze the methodological characteristics of the selected studies; (4) to identify the variables associated to client violence towards the social worker. In order to achieve these objectives, the method was based on a review of the literature on studies of violence towards social workers in Spain through the PRISMA-S guidelines (Rethlefsen et al., 2021). The results show that this phenomenon effectively exists, and cast a light on a situation that social workers experience in isolation. Exploring the phenomenon in a descriptive way, the review provides information on the variables studied and the current extent of violence towards social workers by clients. The lack of studies on this subject underlines the need to continue researching into the problem from both descriptive and inferential perspectives.
... Other studies have reported similar findings on the importance of violence prevention training in HC [41,72]. Comprehensive violence prevention programs have been developed for hospitals and other facilities, and these should be adapted for HC work [72][73][74][75][76][77]. ...
Purpose of Review
To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research?
Recent Findings
HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time.
Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk.
Summary
A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.
... Most research related to reducing violence against healthcare professionals addresses operational interventions and law enforcement strategies, but poor environmental design has also been identified as a risk factor of violence. Both the National Institute for Occupational Safety and Health and OSHA suggest that environmental factors may help reduce the risk of violence in the healthcare workplace (McPhaul et al., 2008). Shaw (2015) recognized that environmental design (e.g., physical barriers) may enhance safety, along with organizational strategies such as personnel composition, policies, practices, and education. ...
... We developed a novel conceptual model for understanding the role of environmental design on workplace violence that considers both crime prevention through environmental design (CPTED) principles (Casteel & Peek-Asa, 2000;Cozens et al., 2005;Crowe, 2000;Matijosaitiene, 2016;McPhaul et al., 2008;Moffatt, 1983;Peek-Asa & Zwerling, 2003) and models of patient aggression (Duxbury & Whittington, 2005;Nijman, 2002;Ulrich et al., 2018). Previous models focused specifically on psychiatric facilities, whereas our model is applicable to healthcare facilities, more broadly (Winstanley & Whittington, 2002). ...
... We organized findings according to the conceptual framework shown in Figure 2, which combines elements derived from models of patient aggression, as well as CPTED principles. CPTED is a place-based crime prevention approach that focuses on where crimes occur (Cozens et al., 2005;McPhaul et al., 2008). Research confirms the relevance of the CPTED approach in healthcare environments (McPhaul et al., 2008). ...
Objective
To systematically review the literature regarding the role of the physical environment in preventing or mitigating aggressive behavior toward healthcare professionals in acute care, outpatient, and psychiatric/behavioral health facilities.
Background
Globally, the incidence of violence against healthcare professionals is alarming. Poor environmental design has been identified as a risk factor of violence toward employees. The design of the physical setting in which healthcare is provided may moderate the incidence and severity of violence against healthcare workers.
Methods
We conducted electronic database searches of PubMed and CINAHL through November 2018.
Result
Findings were organized according to four categories identified in the literature regarding crime prevention through environmental design (CPTED) including natural surveillance, access control, territoriality, and other CPTED elements. Fifteen studies (published between 1991 and 2017) met the inclusion criteria. Of the 15 studies, 4 incorporated environmental interventions. In the 11 remaining studies, physical environment attributes (i.e., layout, location, ambient conditions, equipment) were among the factors affecting violent incidents and staff security. Most study settings were hospital-based (11, with 10 of those specifically focused on emergency departments), followed by behavioral health facilities (4 studies). Design-focused recommendations, such as providing a second door in a triage room and a sub-waiting area inside the treatment zone, were summarized according to CPTED categories.
Conclusion
This review suggests that the physical environment in healthcare facilities may affect the incidence of violence by patients or visitors against staff. Further research is needed to identify environmental design strategies that may protect the safety of healthcare professionals.
... Primary prevention may comprise behavioral trainings that convey communication and de-escalation skills and make nurses feel secure and competent when dealing with critical situations [22,29]. Another important approach for preventing workplace aggression toward nurses is the design of working conditions that reduce the risk of aggressive acts (e.g., adequate space, opportunities to safely exit, adequate lightning, and adequate staffing) [30]. ...
The aim of this study is to obtain a better understanding of the association between the frequency of nurses’ exposure to workplace aggression from patients and their levels of burnout. In particular, we seek to shed light on the role of the availability of follow-up counseling in organizations after critical incidents in mitigating the adverse relationships between physical and verbal aggression and nurses’ burnout. A total of 582 nurses reported how frequently they had experienced physical and verbal aggression from patients in the last 12 months and whether they had the opportunity to receive follow-up counseling in their organization. In addition, nurses rated the extent to which they experienced each of the three dimensions of burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment). The results showed that both physical and verbal aggression were substantially related to the burnout dimensions. Furthermore, we found that the availability of follow-up counseling in organizations attenuated the relationships between physical aggression and all three burnout dimensions. While we found that the availability of follow-up counseling moderated the relationship between verbal aggression depersonalization, the moderating effects were not significant for emotional exhaustion and personal accomplishment. The findings indicate that the availability of follow-up counseling might help minimize the adverse impact of exposure to aggression from patients on nurses’ mental health.
... However, very little of the injury literature has directed attention to work-related injuries involving fire, save for research on firefighter injuries or reports on high profile disasters [3][4][5]. More commonly, the focus is on discrete injury events, such as deaths resulting from falls, machinery incidents, or workplace violence-this despite the potential for fires to produce injuries that are particularly severe and involve multiple victims [6][7][8][9]. As a result, there is little understanding of fire as a workplace injury event, including any characterization of the range of work environments and work activities in which fire plays a role in the injury sequence. ...
Research into workplace injuries traditionally focuses upon discrete injury events, such as falls, violence, contact with machinery and other traumatic events. By comparison, research literature on work-related injury events involving fire is sparse, despite the fact that fires can produce particularly severe injuries and involve multiple victims. Comparatively little is consequently known about the workplaces and workers involved in fire incidents and the circumstances surrounding these ignitions. This research addresses this knowledge gap by reviewing workplace investigation reports of fatal fires conducted by the Occupational Health and Safety Administration in order to identify critical factors in fatal fire incidents between 2013 and 2017. The research indicates that fatal injuries involving fire encompassed a broad range of occupations and work processes. Greater attention to training in hazard recognition and prevention are needed to reduce the threat of fire in work environments where ignition sources coexist with combustible materials.
