Fluent Essays

Write a short paper on the history of workers compensation in Kentucky. 3-5 pages, APA style. You should be able to find information on your jurisdiction through Westlaw, especially through the law journals and periodicals.Sample paper attached sample_short_paper_wc.pdf Unformatted Attachment Preview SAMPLE SHORT PAPER OSH390 Workers Compensation (NOTE: This paper is a little longer than what you may be required to do, but provide the proper citation format and reference list at the end.) Workplace Violence in the Skilled and Long-Term Nursing Industry Introduction Workplace violence is an issue which permeates the entire healthcare industry. According to the Bureau of Labor Statistics healthcare workers are sixteen times more likely to be victims of workplace violence (WPV) than other service workers (Elliot, 1997). Nowhere within the healthcare industry is this issue more acute than in the skilled nursing and long-term care arenas. A 1996 report by the National Institute of Occupational Safety and Health (NIOSH) indicated that 27\% of workplace assaults occurred in nursing homes as compared to 11\% in hospitals (Smith, 1999). For the purposes of this paper the term workplace violence is defined as “violent acts, including physical assaults and threats of assault directed towards persons at work or on duty as a result of harassment, threats, and physical violence” (Gates, 1995). This is a broad designation which captures all types of workplace violence. To add clarity to this discussion workplace violence will be typified accordingly; Type 1 – violent acts committed upon workers incidental to another criminal act (e.g., robberies), Type 2 – violent acts committed upon workers by clients, Type 3 – violent acts committed upon workers by coworkers, and Type 4 – violent acts committed upon workers by interpersonal associates (e.g., spouses or relatives) (NIOSH, 2006). Although, longterm care personnel are exposed to all types of workplace violence this paper will focus 1 on Type 2 violence perpetrated by residents upon staff. This is not implying that other types of workplace violence do not occur in nursing homes nor should it imply that the impacts of Types 1, 3, and 4 workplace violence are also not significant issues. Rather the subject of resident assaults upon staff is so complex that the topic begs its own exploration. Of particular importance to this subject is an analysis of the unique risk factors associated with acts of resident aggression upon staff. Risk Factors A discussion of WPV risk factors should begin with identifying that group of longterm care workers who are at the greatest risk of being assaulted. Unlike hospitals where licensed nursing staff (e.g., RNs or LPNs) deliver the majority of patient care in nursing homes 60 to 80\% of direct resident care is provided by unlicensed certified nursing assistants (CNA). Among the primary functions of the CNA is assisting the resident with the activities of daily living (ADL) including toileting, dressing, and bathing. It is during the assistance with ADLs that CNAs are most frequently assaulted by residents (Gates, 2003). The risk factors that increase the likelihood of resident assaults upon CNAs may be divided into two separate categories; 1) Personal and 2) Occupational risk factors. Personal risk factors include several negative character traits that may be possessed and exhibited by the CNA. These negative traits have the tendency to adversely affect the quality of care that is provided to the resident who then acts out in an aggressive or violent manner to demonstrate their displeasure. It should be understood that many residents are completely dependant upon their caregivers for the most basic of life’s functions which can place them in a state of frustration or otherwise 2 predisposed to act out aggressively. Thus, when care is delayed or it is provided in a discourteous or abrupt fashion the likelihood of violent outburst by the resident is increased. In a study conducted by Donna Gates, Evelyn Fitzwater, and Paul Succop of the University of Cincinnati the researchers found that CNAs with high levels of “trait anger” were more likely to be assaulted by residents (Gates, 2003). Simply stated “trait anger” is a hostile attitude which elicits the resident’s reciprocated hostility and acts of aggression directed towards their caregiver. “Vocational strain” is a term used to describe a person with a poor work attitude, including boredom or lack of interest in their jobs (Osipow, 1998). “Vocational strain” represents another personal characteristic possessed by CNAs that positively correlates to increased resident assaults. It is believed by the researchers that CNAs with high levels of “vocational strain” negatively impacts the quality of the care provided to residents; which in turn elicits their hostility and ultimately outward acts of aggression. Another important trait which influences resident aggression upon CNAs is the concept of “Role ambiguity”. CNAs with high “Role ambiguity” are likely to experience conflicting or unreasonable demands by their supervisors or who may feel that they lack the knowledge or ability to adequately care for a resident. “Role ambiguity” is exacerbated when residents have cognitive impairment or present with a complex medical condition which makes their care even more challenging. This ambiguity creates stress upon the CNA. CNAs with high “role ambiguity” often report high levels of frustration, feelings of helplessness, and difficulties concentrating which ultimately impacts the quality of care they are able to provide to a resident (Gates, 2003). 3 Finally, in a study conducted by Cheryl Anderson of the University of Texas at Arlington the researcher found that nurses who had been the victims of childhood or adult abuse were more likely to be the victims of workplace violence. Victims of abuse may have tendencies “to handle emotionally charged situations with violence or aggression, often a learned behavior developed in response to a history of…abuse” (Anderson, 2002). CNAs with poor coping skills or who experience feelings of helplessness often act out aggressively themselves, thus eliciting aggressive or violent responses from those they are charged with caring for. Therefore, a past history of abuse is considered to be a personal risk factor which increases the CNAs likelihood of being assaulted by a resident. Occupational risk factors that increase the likelihood of assaults upon CNAs include a variety of process, economic, and societal factors. A significant component surrounding WPV issues in long-term care is the lack of robust processes for assessing, reporting, and handling violent residents. This fact if often compounded by numerous factors including the perception of caregivers that resident assaults are a part of the job. This perception has been described as a “divided loyalty, wherein the nurse is torn between allegiance to the professional role of putting the patient’s needs first and attention to his or her needs as a victim of violence” (Lanza, 1992). As a result workplace assaults committed by residents often go unreported which makes identification, assessment, and instituting proper plans of care for violent residents problematic at best. Under reporting may often lead to corporate denial that a problem exists, facility management’s awareness of the problem, and further disempowerment of workers to voice concerns about WPV issues. 4 Societal factors have also increased the risk of violence to CNAs. This is apparent as the number of facilities establishing dementia units has risen due to the need to care for an increasing number of residents with diminished cognitive ability. Caring for persons with Alzheimer’s disease, organic mood disorders, and substance abuse issues all can increase the risks to caregivers (Anderson, 2002). This increased risk is punctuated by the unexpected and violent outbursts that are often typified by those residents that suffer from these mental health issues. Couple this with ineffective or inappropriate training and CNAs are often left with the inability to recognize when a resident is escalating their behaviors or ill equipped to execute deescalating techniques to defuse the violent situation (Gates, 2003). Other occupational risk factors are associated with the economics of the skilled nursing industry which is often described as a “pennies business”. This fact is highlighted by the ever diminishing reimbursements for resident care provided by Federal Medicare and state Medicaid systems. As profit margins wear thin facility administrators are often pressured to cut costs which often results in cutting staff (McCoy, 2001). Cuts in staff negatively impact the caregiver to resident ratio and place an excessive burden upon the CNA. In their study Gates et al., found a direct correlation between the numbers of residents in the CNAs care and an increase in the number of assaults (Gates, 2003). This is attributed to the fact that as the work load increases the caregiver becomes rushed, fatigued, and frustrated resulting in diminished quality of care. This in turn leads to frustrated, angry residents whose propensity to act violently increases in an attempt to show their displeasure. Interventions 5 As has been described, workplace violence is a significant issue in the long-term care business. Therefore, effective and efficient interventions are necessary to assure CNAs and other staff members are provided a safe and healthful place to work. To meet this need a proactive WPV Prevention program must be implemented within the facility. This process begins with a comprehensive assessment of the workplace to determine the true nature and the extent of the vulnerabilities to violence in the facility. In terms of resident aggression this assessment is primarily a process whereby uniform and timely clinical evaluations of residents are completed. The resident assessment process represents an effective administrative control that must then be communicated to all caregivers. This specific administrative control will then translates into work practice controls that assure caregivers take the necessary precautions and avoid behaviors which are known to agitate aggressive or violent residents. These evaluations must take place frequently to assure that any changes in the resident’s cognitive ability or level of agitation is understood and communicated. The process of resident evaluation for aggressive behaviors then becomes a part of the facility’s comprehensive workplace violence prevention program. Other administrative and work practice controls must consider the methods for alerting and summoning help when a resident assault upon staff is taking place. This may include the use of codes, personal alarms, or panic buttons whereby help may be rushed to the scene of an assault. These control methods and work practices also become components of the overall WPV Prevention program. Other facility evaluations may be necessary to identify engineering controls which can eliminate or reduce exposure to workplace violence. These assessments include 6 physical evaluations of resident rooms, procedures rooms, activities rooms, rehabilitation gyms, shower rooms, and grounds. These evaluations should focus on the elimination of physical barriers that could entrap a caregiver and prevent their egress from a violent situation, adequate lighting levels, enhanced communications between staff including; closed circuit television cameras, panic buttons, and personal alarms. Other engineering controls that may be considered include safe rooms for staff and “timeout” rooms for residents who are acting out in aggressive, threatening, or violent ways. Reporting and investigation of incidents is another major component of an effective WPV Prevention program. Failing to report incidents of workplace violence, as discussed earlier, may have a profound effect which allows violence to persist in the workplace. CNAs must be trained and educated in the processes for recognizing when a resident’s actions constitute an assault based on an established and clearly communicated definition. They must also understand that when an assault takes place they have an obligation to report the incident through the appropriate channels. Timely and accurate reporting assures that the incident will be properly investigated and that appropriate engineering and work practice controls can be implemented to prevent future assaults. Under extreme circumstances this may require transferring that resident to a facility capable of providing the level of specialized care required by that resident. CNAs must also understand that the WPV Prevention program is supported by a corporate policy of “Zero Tolerance” towards all forms of violence in the workplace. This includes a system of progressive discipline for all staff who commit acts of violence or who fail to adhere to any of the administrative and work practices that have been 7 established. CNAs that treat residents in an inappropriate, abrupt, or discourteous manner will be subject to disciplinary actions up to and including immediate termination. Lesser infractions including failure to report or failing to follow the prescribed work practices when dealing with aggressive residents will also be subject to progressive disciplinary actions. Training and Education Underscoring all aspects of the WPV Prevention program is the need for a comprehensive CNA training and education program. To be effective the program must focus on several key educational and functional areas particularly as they apply to interacting with aggressive residents or residents with cognitive impairment. The importance of an effective CNA training program cannot be underestimated as nursing homes continue to admit more residents with Alzheimer’s disease and other challenging behavioral disorders. Accenting this need is the vulnerability of the CNA who must often put the welfare of the resident above their own. An effective training program must go beyond merely training CNAs to recognize when residents are agitated or upset and include education that focuses on a higher level of critical thinking. This would include a better understanding of cognitive disorders and the skills necessary to prevent and manage agitation and aggressive behaviors in the senior population. Gates et al., suggests that the education include “opportunities to learn and practice these skills, using case studies or role plays that allow [CNAs] to develop problem-solving methods to handle a variety of care giving situations” (Gates, 2003). Violence prevention education should also have content that helps caregivers to reconcile feelings and emotions that are aroused when residents engage in physically or emotionally abusive 8 behaviors. This type of emotional intelligence education is supported by studies conducted by Roper, Shapira, and Beck who found that CNAs “who viewed the aggressive behaviors as part of the disease process felt confident and satisfied in their care giving (Roper, 2001). Confident and satisfied caregivers are going to provide a higher and more compassionate level of care which has a direct effect upon minimizing instances of resident aggression. From a practical perspective the training and education program must teach skills that meet the requirements of long-term care regulations. Training and education should begin with a fundamental understanding of the physical frailties of the senior population. Furthermore, the education of CNAs must include an understanding of the causes of challenging behaviors in elders and include training in the recognition of the physical, social and treatment based stimuli that may provoke aggressive behaviors. Basic techniques for interacting with behaviorally challenged residents should be emphasized and include methods for approaching and positioning oneself relative to the resident, as well as verbal communication and nonverbal gesturing to reinforce positive behaviors. To this end CNAs must understand that seniors need additional time to process requests and failing to account for this may cause frustration and provoke aggression. Practical techniques that may be taught for preventing difficult behaviors include “behavioral momentum”, “reinforcement of alternative behaviors”, and “behavioral chaining” (Lennox, 2004). “Behavioral momentum” is a technique that capitalizes on positive behaviors residents are willing to exhibit. In other words, if a resident is always willing to go for a walk, but not to go to the dining room for meals use the first behavior to build positive momentum towards the second desired behavior. For example, 9 resident walks may be scheduled just before meals whereby the walks would end in the dining room so that the momentum of the first willing behavior leads to the next without conflict. “Reinforcement of alternative behaviors” is a technique that can be used with a resident to assure that positive behaviors are recognized and rewarded. For example, if a resident persistently exhibits a negative behavior CNAs can be trained to identify the precursors of that negative behavior. They may then intervene prior to that behavior being elicited; in this way the positive anteceding behavior may be rewarded and reinforced. A third technique “behavior chaining” can be used to divide a process into individual tasks, for example, transferring from bed to wheelchair. This technique allows the resident time to gradually chain from one task to the other and minimizes frustration levels. It also allows the CNA to prompt and reward the resident for the completion of small manageable tasks. Although, these techniques can minimize resident/CNA conflicts no amount of education and training, engineering, administrative, or work practice controls will completely eliminate them from occurring. As a result CNAs must also receive training in the form safe behavioral crisis management strategies. These strategies must employ techniques of restraint that are approved for a fragile elder population and that do not elicit further acts of violence. Maximizing resident care and minimizing potential sources of neglect or resident abuse, as well as protecting staff must be kept as the highest priorities of the WPV Prevention Program. As has been previously stated no amount of intervention or training and education can completely eliminate acts of violence upon staff. Due to this fact postincident medical management and psychological counseling is a vital component to the WPV Prevention program. Failing to provide help to staff who suffer physical or 10 emotional abuse can cause resident care to spiral downward as CNAs suffer from the untreated affects of abuse. Beyond the physical injuries, which can be relatively easy to treat, lay the potential devastating effects of the psychological abuse inflicted upon the CNA. To this point, facility administrators must assure that adequate psychological counseling is made available to staff who seek assistance. Psychological counseling may be provided in a variety of ways including traditional occupational health clinics with access to mental health professionals, as well as through the use of employee assistance programs (EAP). EAP programs can be beneficial as they allow employee’s access to mental health professionals seven days-a-week and 24-hours a day. EAP programs may also be contracted to provide additional on-site services; including postincident stress debriefing, group therapy, and one-on-one counseling. Despite all of the interventions that may be deployed at a facility the issue of workplace violence is a dynamic and complex subject needing attention. Therefore WPV interventions must be periodically evaluated to assure their effectiveness. Recordkeeping and Periodic Evaluations The best method for assuring the effectiveness of the WPV Prevention program and its many related control methodologies, as well as training programs is periodic evaluations. To facilitate this process it is necessary ... Purchase answer to see full attachment