Workplace violence (WPV) in healthcare is recognized as a serious occupational hazard (Occupational Safety and Health Administration [OSHA], 2015). Unique factors that increase the risk for WPV in home care include working alone, working in neighborhoods with high crime rates, lack of WPV prevention training for employees, the presence of weapons in the home or community, and seeing patients with a history of violent behavior (Nakaishi et al., 2013; OSHA). Exposure to WPV can occur when entering the patient's community as well as the patient's home. Preparation, awareness, alertness, and prevention (PAAP) include strategies that should be implemented prior to and during the home visit to promote the safety of home healthcare workers.

Preparation. Home healthcare workers (HHCs) must be mentally prepared for the potential exposure to WPV. Understand the concept of "universal precautions for violence"-meaning, violence should be expected but can be avoided or mitigated through preparation (OSHA, 2015). If available prior to the home visit, review the patient's history and crime statistics of the neighborhood. Ensure your cell phone is fully charged and have a backup charger with you. Have a list of emergency numbers programmed into your cell phone on speed dial. Choose your attire wisely! Wear clothing that cannot be easily grabbed, no jewelry, and no purses should be carried into the home. Do not wear anything around your neck that could be used to strangle you. Wear gym shoes in case you need to run from a dangerous situation.

Awareness. Be aware of your environment at all times, in both the neighborhood and the patient's home. Know where the nearest police station is located. Observe people in the neighborhood and the patient's home for any suspicious activity. Be aware of the presence of weapons during the home visit. Identify exit points in the home.

Alertness. Trust your instincts! Be alert to signs of imminent danger. Don't enter a community or home if you feel unsafe.

Prevention. Learn how to control personal body language and verbal responses to negative behavior from patients, family members, and people in the community. The common practice of charting in the car is dangerous and should be avoided. Instead, complete charting in a safe location, such as the agency office. If possible, eliminate home visits after dark. If the agency provides, use a buddy system or escort service for high-risk visits or visits in high crime neighborhoods.

The agency can promote safety by providing safety and health training that is based on the concepts of PAAP. According to OSHA's Guidelines for Preventing Workplace Violence (2015), safety and health training are essential to increase worker safety awareness and alertness to WPV, and to know how to protect themselves through established policies. Safety and health training prepare workers for unforeseen hazards in the workplace, increase knowledge of WPV, and provide workers with the tools needed to respond to and prevent WPV.

Safety and health training should be provided during orientation, annually, and when content is updated (OSHA, 2015). Ensure training content is specific to HHCs and their work environment (Nakaishi et al., 2013). At minimum, content should cover the definition of WPV, risks for WPV, prevention policies, and procedures for reporting WPV (OSHA). Lastly, agencies should develop an organized database for tracking all WPV incidents and HHCs' participation in safety and health training.

REFERENCES