Study Suggests Perception of Violence Increases Musculoskeletal Pain

Musculoskeletal pain may be triggered by exposure to violence in the workplace. A new study suggests health care workers who were assaulted by patients or their visitors were more likely to report low back pain, as well as pains in the shoulder, wrist or hand, and knee.

The study, Violence at the Workplace Increases the Risk of Musculoskeletal Pain Among Nursing Home Workers, was published online in Occupational and Environmental Medicine and suggests a direct link between workplace physical violence and musculoskeletal symptoms. It points to the need to implement improved safety measures, particularly among nursing home clinical staff.

Researchers from the Department of Work Environment at the University of Massachusetts, Lowell surveyed more than 900 clinical nursing home workers at 12 nursing homes within a single company located in Maryland and Maine from May 2006 to November 2007. The respondents were asked whether they had experienced pain in various body parts in the preceding three months and whether they had been hit, kicked, grabbed, shoved, pushed, or scratched by a patient or visitor during that time.

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"A new finding is the dose-response relationship between violent assaults and pain," the study said. "The prevalence of pain increased linearly with the increasing number of assaults, being on average double or even triple among those assaulted three or more times."

Their findings also included:

One out of two nursing home workers reported having been physically assaulted at least once in the preceding three months and one in four had been assaulted multiple times.
The prevalence of low back pain increased from 40 percent among non-assaulted workers to 70 percent among those assaulted three or more times.
Widespread pain was three times more prevalent among those reporting at least three assaults, compared to no assaults.

Many workers exposed to violent assaults also reported a less safe work environment. This combination was associated with an increased risk of pain in most areas of the body. However, being assaulted in a safer work environment had little, if any, effect, according to the study.

Perception is reality. "Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe," according to the study.

Researchers did not examine the possible reasons for the increase in pains reported among nursing home staff exposed to violence in unsafe environments, although they did suggest possible causes.

"One plausible explanation could be related to stress and consequent delayed tissue healing, as well as altered pain tolerance," the study said. "Frequent and prolonged threats of violence may produce constant anticipation of pain, which itself may be even worse than the actual pain experience."

Both musculoskeletal pain and violence are not uncommon among health care workers. The researchers cited studies showing approximately nine out of 10 nurse aides had experienced pain during the preceding two weeks. They also said nearly half of all nonfatal injuries from violent acts against U.S. workers occur in the health care sector with the most assaulted workers being the aides in nursing homes.

Creating a safer work environment. Mitigating the risk of violence involves developing a safety and health program that includes management commitment, employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting, according to experts. The National Institute for Occupational Safety and Health has several additional suggestions.

"Nursing homes and hospitals have policies and practices on how violent or potentially violent patients are to be handled. It is imperative that these policies be well-understood by the staff," said Dr. Teresa Bartlett, medical director for Sedgwick CMS in Troy, Mich. "It is essential if a situation escalates to the point of violence that local law enforcement be contacted."

Bartlett also says supervisors should be trained to recognize the warning signs of violence and report suspicious situations to management, such as seeing a weapon or hearing veiled threats being made.

Also, informed employees are key. "You must consider that the employees need to know what to do in the event of workplace violence. Many employers find practice drills helpful," Bartlett said. "Knowing and practicing the process helps individuals avoid panic and may ultimately save lives."

Read more at the WorkersComp Forum homepage.

January 31, 2011

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