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HEALTHCARE AND SOCIAL ASSISTANCE

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Outputs: Publications

Selected Publications


Research Needs

Healthcare and Social Assistance - Advancing priorities through research and partnerships
DHHS (NIOSH) Publication 2009-149 (June 2009)
Most people think of the Healthcare and Social Assistance (HCSA) industry as providing clean, sterile and safe places to work. In reality, HCSA workers are exposed to many hazards that can affect their health and well-being. Their work exposes them to life threatening infections, such as SARS, HIV and hepatitis. They work with highly toxic cancer treating drugs and various chemical agents. They perform physically demanding tasks, such as lifting patients. In fact, this sector of the economy is highly hazardous and puts workers at a surprising risk for illness and injury.

State of the Sector | Healthcare and Social Assistance - Identification of Research Opportunities for the Next Decade of NORA - Executive Summary
DHHS (NIOSH) Publication 2009-138 (June 2009)
This document was developed by the NORA HCSA Sector Council to address the “state of the sector,” including the magnitude and consequences of known and emerging health and safety problems, important knowledge gaps, and opportunities for research to improve the “state of the sector” over the next decade of NORA.

State of the Sector | Healthcare and Social Assistance - Identification of Research Opportunities for the Next Decade of NORA
DHHS (NIOSH) Publication 2009-139 (June 2009)
This document addresses the research needs of the occupational safety and health community within the Healthcare and Social Assistance (HCSA) industrial sector. This important industrial sector represents about 11% of the U.S. workforce - approximately 17.4 million workers in 2006 - of which 80% are in healthcare. The HCSA sector contains 12 of the 20 fastest growing occupations, and the projected growth of this sector through 2014 exceeds that of any other industrial sector. Workers in the HCSA sector are exposed to a wide range of health and safety hazards including infectious, chemical, and physical agents; lifting and repetitive tasks (ergonomic hazards); stress (psychological hazards); workplace violence; and risks associated with suboptimal organization of work.


Asthma

Asthma and Respiratory Symptoms in Hospital Workers Related to Dampness and Biological Contaminants
Indoor Air ; 19(4):280-290 (Aug 2009)
A cluster of six work-related asthma cases from one hospital department, whose symptoms arose during a time of significant water incursions, prompted NIOSH to conduct a survey of respiratory health in employees working in the sentinel cases hospital and a nearby hospital without known indoor environmental concerns. Our data imply new-onset of asthma in relation to water damage, and indicate that work-related respiratory symptoms in hospital workers may be associated with diverse biological contaminants.


Bloodborne Pathogens

Occupational Hazard - Hospital Management
Practical Patient Care: 1-5 (Mar 2009)
This article examines the prevalence of bloodborne infections and how such infections can be prevented through national guidelines, simple precautions and staff reporting.


Chemical Hazards

Is Orthophthaldehyde a Safe Alternative to Glutaraldehyde?
Toxicologist; 114(1):66 (Mar 2010)
The present study was designed to evaluate the dermal irritation and sensitization potential of OPA. Results demonstrated the dermal irritation and sensitization potential of OPA in an animal model raising concern about the skin irritation and sensitization potential of OPA among healthcare workers who are potentially exposed to the chemical.

Orthophthaldehyde Inhalation Induces Immune Activation in the Nasal Mucusa and Draining Lymph Nodes in Mice
Toxicologist; 108(1):313 (Mar 2009)
The purpose of this study was to determine the respiratory toxicity of OPA using a murine model. A nose-only vapor inhalation system was used to expose mice to OPA vapor for 4 hours/day for 3 consecutive days followed by sacrifice on day 5. The lungs, nasal mucosa and head-draining lymph nodes were collected and processed for cytokine gene expression analysis. Expressions of TNFalpha and IL-1beta, cytokines important for activation and migration of dendritic cells, were increased in the draining lymph nodes as well as the nasal mucosa. Increased IL-4 and IL-10 expression was observed in the draining lymph nodes as well as increased IL-4 expression in the nasal mucosa. In contrast, the expression of IFNã was not changed in either tissue following OPA inhalation. Lung cytokine expression was also examined; however, no changes were evident. These data demonstrate that OPA inhalation induces an immune response locally in the nasal mucosa. Importantly, OPA inhalation induced activation of lymphocytes in the mandibular lymph nodes that drain the nasal mucosa, thus supporting the potential for sensitization to this chemical. The Th2-dominant expression pattern in the draining lymph nodes suggests that OPA may have the potential to cause respiratory sensitization.

Cleaning Products and Work-Related Asthma
J Occup Environ Med 2003 May; 45(5):556-563
Data from four state-based surveillance systems (CA, MA, MI and NJ) identified 236 (12%) of 1915 cases of work related asthma being associated with exposure to cleaning products. Most likely exposures were in medical settings and involved nurse/nurses aides and janitors/cleaners. The authors recommended that additional research is needed to characterize specific agents and circumstances of use.


Child Day Care

Occupational Health and Safety Issues in Child-Care Work
Pediatrics; 94(6):1079-1080 (Dec 1994)
This paper describes health and safety issues in child day care settings, including communicable diseases, occupational stress, and ergonomic hazards.

Varicella-Zoster Virus Susceptibility in Day-Care Workers
Appl Occup Env Hyg;7(3):191-194 (Mar 1992)
The purpose of this study was to determine the proportion of day care workers susceptible to Varicella-zoster virus (VZV) in child day care centers and to compare these data to susceptibility rates in other adult populations, mainly hospital personnel.


Economics

Safe Patient Handling and Mobility-Interprofessional National Standards (Book available)
American Nurses Association (June 2013)
ANA, in collaboration with a national working group, developed national interdisciplinary SPHM standards to help hospitals and other healthcare employers develop safe, effective, and enduring programs. The standards are applicable across the care continuum.

Costs of Occupational Injury and Illness within the Health Services Sector
Int J Health Serv; 35(2):343-359 (Apr-Jun 2005)
This paper analyzed data from BLS and other sources to estimate and compare costs across occupations, and types of injuries and illnesses within the health services sector. The hospital industry was the third most expensive of 313 U.S. industries; injuries and illnesses comprised roughly 90% and 10%, respectively, of total costs.


Engineering Controls

Controlling Health Hazards to Hospital Workers-A Reference Guide
New Solutions, 23(Suppl):1-167 (2013)
This reference guide identifies more than 150 engineering controls for more than 30 hazards found in the hospital setting. The identified controls are based on published studies, guidelines and hospital walk-throughs. Published studies of control effectiveness are also included in this document.

Control of Smoke From Laser/Electric Surgical Procedures
DHHS (NIOSH) Publication No. 96-128 (March 1998)
This document describes how to control airborne contaminants generated by lasers and electrosurgical devices.


Ergonomics

Addressing the Need for Research on Bariatric Patient Handling
Rehabil Nurs 2010 Nov/Dec; 35(6):242-247
During the past 3 decades numerous studies have documented the high prevalence of patient handling-related musculoskeletal injuries among healthcare workers and evaluated ergonomic interventions using mechanized equipment for lifting and moving patients. The National Institute for Occupational Safety and Health is conducting a new study to evaluate bariatric patient handling hazards and interventions and identify evidence-based best practices for handling this population.

Introduction to Ergonomics for Healthcare Workers?
Rehabil Nurs 2010 Sep/Oct; 35(5):185-191
This article provides a general overview of ergonomics - what it is, how it can be used to help design safe work, and why all healthcare workers and administrators should know and understand how excessive work demands can lead to increased risk of work-related MSDs. The article will also explain technological solutions that can be implemented to reduce the risk of work-related MSDs for healthcare workers.

The Need for Research on Ergonomics in Bariatric Patient Handling
In B. Brinkerhoff (Ed.), Ergonomics: Design, Integration and Implementation, Nova Science Publishers, Inc., New York. (2009)
This chapter reviews research on ergonomic interventions for reducing healthcare workers’ risk of overexertion injuries from lifting and moving patients. Although numerous studies have demonstrated the effectiveness of standard-sized patient handling equipment for patients who are not extremely obese, new research is needed to evaluate the use of specialized equipment for lifting and moving extremely obese, or “bariatric patients.

Safe Patient Handling for Rehabilitation Professionals
Rehabilitation Nursing, 35 (5), 216-222 (Sept/Oct 2010).
Information about patient handling technology that is effective in reducing the risk of work-related MSDs from performing therapeutic patient handling and movement tasks is presented and discussed in this article.


Hazardous Drugs

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2010
DHHS (NIOSH) Publication No. 2010-167 (September 2010)
In this Alert, NIOSH presents a standard precautions or universal precautions approach to handling hazardous drugs safely: that is, NIOSH recommends that all hazardous drugs be handled as outlined in this Alert. Therefore, no attempt has been made to perform drug risk assessments or propose exposure limits. The area of new drug development is rapidly evolving as unique approaches are being taken to treat cancer and other serious diseases.

Personal Protective Equipment for Health Care Workers Who Work with Hazardous Drugs
DHHS (NIOSH) Publication No. 2009-106 (October 2008)
Health care workers who handle hazardous drugs are at risk of skin rashes, cancer, and reproductive disorders. NIOSH recommends that employers provide appropriate personal protective equipment (PPE) to protect workers who handle hazardous drugs in the workplace.

Medical Surveillance for Health Care Workers Exposed to Hazardous Drugs
DHHS (NIOSH) Publication No. 2007-117 (April 2007)
Health care workers who handle, prepare, or administer hazardous drugs may face risks to their own health such as skin rashes, cancer, and reproductive disorders. NIOSH recommends that employers establish a medical surveillance program to protect workers who handle hazardous drugs in the workplace.


Healthcare Workers at Correctional Facilities

Protect Your Employees with an Exposure Control Plan Brochure
DHHS (NIOSH) Publication No. 2007-158
Provides information to medical service administrators and supervisors about improving facility Exposure Control Plans.

Encourage Your Workers to Report Bloodborne Pathogen Exposures Brochure
DHHS (NIOSH) Publication No. 2007-159
Provides information for encouraging the reporting of worker bloodborne pathogen exposure in correctional facilities.


Home Healthcare

NIOSH Hazard Review: Occupational Hazards in Home Healthcare
DHHS (NIOSH) Publication No. 2010-125 (January 2010)
This document describes occupational hazards in home healthcare (e.g., muscuoloskeletal overexertion, violence, needles and bloodborne pathogens, etc.) and suggests preventive strategies for employers and workers.

Risk Factors Associated with Patient Assaults of Home Healthcare Workers
Rehabil Nurs 2010 Sep/Oct; 35(5):206-215
This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year.


Infectious Agents

Cluster of Severe Acute Respiratory Syndrome Cases among Protected Healthcare Workers - Toronto , Canada , April 2003
MMWR; 52(19):433-436 (May 2003)
This report summarizes a cluster of severe acute respiratory syndrome (SARS) among healthcare workers in a hospital where infection-control precautions either had not been instituted or had been instituted but not followed.


Latex Allergy

Latex Allergy: Past and Present
Int Immunopharmacol; 2(2-3):225-238 (Feb 2002)
This manuscript provides a brief history of latex allergy, and a review of the following: manufacturing process for dipped latex products, the 11 latex allergens that have been characterized and received allergen designations by the International Union of Immunological Societies, and the methods used in exposure assessment, the epidemiology and clinical management of latex allergy, and the use of animal models in investigating mechanisms underlying latex allergy.

Clinical and Occupational Outcomes in Healthcare Workers with Natural Rubber Latex Allergy
Ann Allergy, Asthma, & Immun; 90(2):209-213 (Feb 2003)
The purpose of this study was to retrospectively evaluate (via questionnaire) health and economic outcomes in 67 Healthcare Workers identified with natural rubber latex (NRL) allergy and percutaneous reactivity to NRL. Symptoms included urticaria in 67 (100%), rhinitis in 23, asthma in 25 and anaphylaxis in 4 workers. Clinical symptoms in this group of HCWs were favorable after institution of interventions (non-NRL gloves or workplaces), but incurred deleterious consequences in a minority of workers.

Latex Allergy: A Prevention Guide
DHHS (NIOSH) Publication No. 98-113

Preventing Allergic Reactions to Natural Rubber Latex in the Workplace
DHHS (NIOSH) Publication No. 97-135
En Español
Detailed description of latex allergy including presentation of existing data and description of six case reports of workers who developed latex allergy. The document also presents NIOSH recommendations for minimizing latex-related health problems in workers while protecting them from infectious materials.


Musculoskeletal Disorders and Interventions

A Review of Work Schedule Issues and Musculoskeletal Disorders with an Emphasis on the Healthcare Sector
Industrial Health; 46: 523-34 (2008)
Musculoskeletal disorders (MSDs) are a significant cause of morbidity in healthcare workers. The purpose of this report is to assess research progress and gaps across studies that examined the relationship between demanding work schedules and MSD outcomes. A literature search identified 23 peer-reviewed publications that examined MSDs and long work hours, shift work, extended work shifts, mandatory overtime, or weekend work. Eight studies that examined long work hours and had some controls for physical job demands reported a significant increase in one or more measures of MSDs. The review discusses research gaps including methodological issues and suggests research priorities.

Musculoskeletal problems of the Neck, Shoulder, and Back and Functional Consequences in Nurses
Am J Ind Med 2002 Mar; 41(3):170-178
This study involved the analysis of neck, shoulder and back problems from 1,163 working nurses. The authors found that 46%, 35% and 47% of nurses had neck, shoulder or back pain within the past year and suggest opportunities for intervention.

Reduction in Injury Rates in Nursing Personnel Through Introduction of Mechanical Lifts in the Workplace
Am J Ind Med; 44(5):451-457 (Nov 2003)
This study evaluated injury and lost work day rates before and after the introduction of mechanical lifts in acute care hospitals and long-term care (LTC) facilities. The post-intervention period showed decreased rates of musculoskeletal injuries, lost workday injuries and total lost work days due to injury, with larger reductions being observed in LTC facilities than in hospitals. This study showed that patient lifts can be effective in reducing occupational musculoskeletal injuries to nursing personnel in both LTC and acute care settings.

An Evaluation of a Best Practices Musculoskeletal Injury Prevention Program in Nursing Homes
Inj Prev; 10(4):206-211 (Oct 2004)
The objective of this study was to conduct an intervention trial of a "best practices" musculoskeletal injury prevention program designed to safely lift physically-dependent nursing home residents. A pre-post intervention trial and cost-benefit analysis at six nursing homes over a 6-year period was designed and involved a cohort of 1,728 nursing staff. The "best practices" program consisted of mechanical lifts and repositioning aids, a zero-lift policy, and employee training on lift usage. The results showed a significant reduction in resident handling injury incidence, WC costs, and lost workday injuries after the intervention.


Needlesticks

Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel
DHHS (NIOSH) Publication No. 2008-101 (October 2007) (Supersedes Publication 2007-132)
This document was developed by the Occupational Safety and Health Administration (OSHA), Department of Labor, and the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Department of Health and Human Services.

NIOSH Alert: Preventing Needlestick Injuries in Healthcare Settings
DHHS (NIOSH) Publication No. 2000-108
This booklet describes the risk of needlestick injury and prevention strategies.
En Espanol

Worker Health Chartbook 2004: Bloodborne Infections and Percutaneous Exposures
DHHS (NIOSH) Publication No. 2004-146
Provides data from the CDC about two of the major occupational bloodborne infections-hepatitis B and HIV, the virus that causes AIDS.


Organization of Work

Personal Safety for Nurses. In Advances in Patient Safety & Quality - An Evidence-Based Handbook for Nurses
AHRQ Publication No. 08-0043 (2008)..
This chapter presents major research findings that link common work stressors and hazards to selected health outcomes. These stressors include aspects of the way work is organized in nursing (e.g. shift work, long hours, overtime) and psychological job demands, such as work pace. In addition, aspects of direct care work that influence nurse safety will be discussed, including the impact of physical job demands such as patient lifting and awkward postures, protective devices to prevent needlesticks, and potential for violence. Where, possible, interventions that have demonstrated effectiveness to reduce the risk of illness and injury are presented, as well as gaps in knowledge that can spur new lines of research inquiry.

Nurses, Smoking, and Immunity: A Review
Rehabil Nurs 2010 Sep/Oct; 35(5):198-205
Nurses regularly are exposed to a variety of occupational hazards. In addition to identified occupational exposures, exposure to smoking remains a major concern. This article reviews the prevalence of smoking among nurses working in the United States and discusses their reasons for smoking.

Strategies for Nurses to Prevent Sleep-Related Injuries and Errors
Rehabilitation Nursing. 35 (5) (Sept/Oct 2010).
Rehabilitation nurses work shift schedules or long hours to provide essential patient services around the clock. This article gives an overview of selected declines in cognitive performance that are associated with inadequate sleep and several factors that increase risk for fatigue-related errors. Selected strategies for nurses and managers to reduce these risks are discussed, such as better sleep practices, improved work schedule design, naps, caffeine, exposure to light, and rest breaks. Both nurses and managers share responsibility for implementing strategies to reduce risks from inadequate sleep.

Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
N Engl J Med; 351(18):1838-1848 (Jan 2005)
This study compared the rates of serious medical errors made by interns while working according to traditional schedule with extended work shifts and while working an intervention schedule that eliminated extended work shifts. The interns made 36% more serious errors during the extended work schedules than during the intervention schedule. Recommendations were made relative to eliminating extended work shifts and reducing the number of hours interns work per week.

Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries and Health BehaviorsDHHS (NIOSH) Publication No. 2004-143
Presents a review of the methods and findings from 52 studies that examined the relationship between long work hours and selected health outcomes. Also provides recommendations on issues and priorities to consider in future research.

Shift Work and Risk of Spontaneous Abortion in Nurses
Am J Epidemiol; 16 1(11)(Suppl):S127 (June 2005)
Evidence suggests that work schedule, including rotating work and night work, may have an adverse effect on reproductive outcome, but results from these studies are ambiguous, and there are few studies of U.S. health care workers. NIOSH examined this question among 7,688 female participants of the Nurses' Health Study II, a prospective U.S. cohort established in 1989. Preliminary results suggest that women who work nights during their first trimester have an increased risk of miscarriage compared to women who work days.


Personal Protective Equipment and Clothing

Recommendations for the Selection and Use of Respirators and Protective Clothing for Protection Against Biological Agents
DHHS (NIOSH) Publication No. 2009-132 (April 2009)
This document is based on current understanding of the potential agents and existing recommendations for biological aerosols and is orient ed toward acts of terrorism. The recommendations provided here do not address and are not applicable to controlled use of biological agents in biosafety laboratories. For information on precautions in the laboratory settings, please consult http://www.cdc.gov/od/ohs/biosfty/biosfty.htm.

TB Respiratory Protection Program In Healthcare Facilities: Administrator's Guide
DHHS (NIOSH) Publication No. 99-143 (September 1999)
Contains information specific to tuberculosis but also provides useful information on respirators, including types used to protect healthcare workers who may be exposed to SARS. Includes section on user seal check and fit-testing.


Safety Culture

Improving Patient and Worker Safety Opportunities for Synergy, Collaboration and Innovation
The Joint Commission (2012)
This monograph is intended to stimulate greater awareness of the potential synergies between patient and worker health and safety activities. It describes a range of topic areas and settings in which synergies exist between patient safety and worker health and safety activities. The monograph also describes the importance of safety culture and why high reliability organizations are concerned with safety for both patients and health care workers.

Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care
National Patient Safety Foundation (2013)
This report looks at the current state of healthcare as a workplace, highlights vulnerabilities common in health care organizations, discusses the costs of inaction, and outlines what a healthy and safe workplace would look like. The report concludes with seven recommendations for actions that organizations need to pursue to effect real change.


Slips, Trips, Falls

Slip, Trip, and Fall Prevention for Healthcare Workers
DHHS (NIOSH) Publication No. 2011-123 (December 2010)
According to the U.S. Bureau of Labor Statistics [2009], the incidence rate of lost-workday injuries from slips, trips, and falls (STFs) on the same level in hospitals was 38.2 per 10,000 employees, which was 90% greater than the average rate for all other private industries combined (20.1 per 10,000 employees). STFs as a whole are the second most common cause of lost-workday injuries in hospitals.

Developing Evidence-based Iinterventions to Address the Leading Causes of Workers' Compensation Among Healthcare Workers
Rehabil Nurs 2010 Nov; 35(6):225-235, 261
The purpose of this article is to summarize the research and outreach efforts of NIOSH and their partners to address the leading occupational injury hazards facing healthcare workers. This article also provides an overview of the changes that are occurring in the healthcare industry as a result of the evidence-based research on safe patient handling and STF prevention that has been conducted in recent years.=

Evaluation of a Comprehensive Slip, Trip and Fall Prevention Programme for Hospital Employees
Ergonomics; 51(12):1906-1925 (December 2008)
The objectives of this 10-year (1996-2005) longitudinal study were to: 1) describe occupational STF injury events in hospitals; 2) evaluate the effectiveness of a comprehensive programme for reducing STF incidents among hospital employees. The comprehensive prevention programme included analysis of injury records to identify common causes of STFs, on-site hazard assessments, changes to housekeeping procedures and products, introduction of STF preventive products and procedures, general awareness campaigns, programmes for external ice and snow removal, flooring changes and slip-resistant footwear for certain employee subgroups.=


Tuberculosis (TB)

Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings
DHHS (NIOSH) Publication 2009-105
Provides guidance for using UVGI systems to kill or inactivate airborne TB bacteria.=

Health Hazard Evaluations (HHEs): Tuberculosis (1990-1999)
DHHS NIOSH Publication No. 2001-116 (2001)
Titles and summaries of Health Hazard Evaluations conducted from 1990 through 1999 related to Tuberculosis, organized by type of facility.


Veterinary Healthcare Workers

Safe Handling of Hazardous Drugs for Veterinary Healthcare Workers
DHHS NIOSH Publication No. 2010-150 (June 2010)
Veterinary healthcare employees working where hazardous drugs are handled may face health risks. Many of these workers treat small companion animals (primarily cats and dogs), but also larger animals such as horses, with antineoplastic and other drugs that may be hazardous to humans. NIOSH recommends establishing a program to provide appropriate protective measures for veterinary healthcare workers exposed to hazardous drugs.

Preventing Worker Deaths and Injuries When Handling Micotil 300®
DHHS NIOSH Publication No. 2007-124 (April 2007)
Livestock producers, veterinarians, and other workers may be exposed to the toxic hazards of the animal antibiotic Micotil 300® through needlestick injuries, skin cuts, puncture wounds, and contact with skin and mucous membranes. Cardio-toxic effects of Micotil 300® on the human heart, including a reduced cardiac contractility and tachycardia (rapid heart beat), can be severe enough to cause death.


Violence

Workplace Violence Prevention in the Mental Health Setting
NOIRS 2003 Abstracts of the National Occupational Injury Research Symposium 2003, Pittsburgh, Pennsylvania
The purpose of this study was to evaluate the effectiveness of violence prevention guidelines in the in-patient mental healthcare setting.

Risk Factors Associated with Patient Assaults of Home Healthcare Workers
Rehabilitation Nursing, 35 (5), 206-215 (2010).
This article describes a NIOSH survey study of 677 home care aides and nurses which explored risk factors associated with physical assaults by patients. Three significant risk factors were identified, including patient handling, patient dementia, and perceived threats of violence by others in and around patients’ homes. Assaulted workers and workers perceiving threats by others were significantly more likely to shorten home care visits, raising concerns regarding the quality of patient care.

Violence: Occupational Hazards in Hospitals
DHHS (NIOSH) Publication No. 2002-101 (April 2002)
En español
All hospitals should develop a comprehensive violence prevention program. No universal strategy exists to prevent violence. The risk factors vary from hospital to hospital and from unit to unit. Hospitals should form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them. All hospital workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.

Reducing Assaults Against Nursing Home Caregivers
Nurs Res; 54(2): 119-127 (Mar-Apr 2005)
The objective of this study was to test the effectiveness of a violence-prevention intervention, on the basis of Social Cognitive Theory to increase knowledge, self-efficacy and skills, and to decrease assaults.


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  • Page last reviewed: October 31, 2012
  • Page last updated: February 28, 2014
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