{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:11:26Z","timestamp":1784707886280,"version":"3.55.0"},"reference-count":48,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T00:00:00Z","timestamp":1672099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: People with advancing dementia may be dependent on community services from home care workers and nurses to be supported at home. However, these care workers face difficulty undertaking their roles due to challenging behaviours or occupational violence. This study aimed to explore the challenges faced by home care workers and nurses working with people diagnosed with dementia in the community, to identify job demands contributing to their vulnerability to occupational violence, and to determine ways to help manage occupational violence. Methods: A qualitative descriptive study was conducted by interviewing 10 homecare workers and six registered nurses from agencies in South Australia and New South Wales, Australia. Interviews were audiotaped, transcribed and inductive thematic data analysis was conducted. Results: The following themes were identified: (i) sources of threats; (ii) categories of violent, threatening or challenging behaviour; (iii) aggravating factors; (iv) early warning signs; (v) education and training; (vi) managing occupational violence, (vii) resources, (viii) outcomes associated with exposure to occupational violence. Conclusion: Serious issues were identified by participants, yet very little is known about occupational violence for these community care workers. Findings can inform what aspects of work design can be improved to moderate the effects of occupational violence exposure or mitigate rates of exposure, to enable long-term services for people with dementia.<\/jats:p>","DOI":"10.3390\/ijerph20010438","type":"journal-article","created":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T05:42:48Z","timestamp":1672206168000},"page":"438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Occupational Violence Experienced by Care Workers in the Australian Home Care Sector When Assisting People with Dementia"],"prefix":"10.3390","volume":"20","author":[{"given":"Atticus","family":"Maddox","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-2051","authenticated-orcid":false,"given":"Lynette","family":"Mackenzie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,27]]},"reference":[{"key":"ref_1","unstructured":"Mavromaras, K.G., Knight, G., Isherwood, L., Crettenden, A., Flavel, J., Karmel, T., Moskos, M., Smith, L., Walton, H., and Wei, Z. (2017). 2016 National Aged Care Workforce Census and Survey-The Aged Care Workforce, Department of Health."},{"key":"ref_2","unstructured":"Australian Bureau of Statistics (2013). 1220.0-ANZSCO-Australian and New Zealand Standard Classification of Occupations, Version 1.3."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1080\/02678373.2014.1003995","article-title":"Health and well-being of older workers: Comparing their associations with effort\u2013reward imbalance and pressure, disorganisation and regulatory failure","volume":"29","author":"Bohle","year":"2015","journal-title":"Work. Stress"},{"key":"ref_4","unstructured":"Australian Bureau of Statistics (2009). 4436.0-Caring in the Community."},{"key":"ref_5","unstructured":"Bohle, P., Finn, J., Quinlan, M., and Rawlings-Way, O. (2009). The Occupational Health and Safety of Homecare Contract Workers in Adelaide and the Barossa Region, Office of the Employee Ombudsman."},{"key":"ref_6","first-page":"407","article-title":"Home health care patients and safety hazards in the home: Preliminary findings. In agency for healthcare research and quality","volume":"1","author":"Gershon","year":"2008","journal-title":"Adv. Patient Saf. New Dir. Altern. Approaches"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1002\/ajim.22287","article-title":"Characterising the nature of home care work and occupational hazards: A developmental intervention study","volume":"57","author":"Markkanen","year":"2014","journal-title":"Am. J. Ind. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Boris, E., and Klein, J. (2012). Caring for America: Home Health Workers in the Shadow of the Welfare State, Oxford University Press.","DOI":"10.1093\/acprof:oso\/9780195329117.001.0001"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1177\/0733464813495958","article-title":"Determinants of longer job tenure among home care aides. What makes some stay on the job while others leave?","volume":"33","author":"Butler","year":"2014","journal-title":"J. Appl. Gerontol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40886-016-0015-8","article-title":"Working towards a definition for workplace violence actions in the health sector","volume":"2","author":"Boyle","year":"2016","journal-title":"Saf. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/1362480613511980","article-title":"Workplace violence: Extending the boundaries of criminology","volume":"18","author":"Schindeler","year":"2013","journal-title":"Theor. Criminol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hanson, G.C., Perrin, N.A., Moss, H., Laharnar, N., and Glass, N. (2015). Workplace violence against homecare workers and its relationship with workers health outcomes: A cross-sectional study. BMC Public Health, 17.","DOI":"10.1186\/s12889-014-1340-7"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1080\/02678373.2011.563133","article-title":"Exposure to psychological aggression at work and job performance: The mediating role of job attitudes and personal health","volume":"25","author":"Schat","year":"2011","journal-title":"Work. Stress"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1300\/J027v26n01_05","article-title":"Abuse and violence during home care work as predictor of worker depression","volume":"26","author":"Muntaner","year":"2007","journal-title":"Home Health Care Serv. Q."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1177\/0886260508317182","article-title":"Prevalence and mental health correlates of harassment and discrimination in the workplace: Results from a national study","volume":"24","author":"Rospenda","year":"2009","journal-title":"J. Interpers. Violence"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1080\/0267837031000148424","article-title":"Post-trauma symptoms in health workers following physical and verbal aggression","volume":"17","author":"Walsh","year":"2003","journal-title":"Work Stress"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ijnurstu.2016.06.001","article-title":"Healthcare staffs\u2019 experiences and perceptions of caring for people with dementia in the acute setting: Qualitative evidence synthesis","volume":"61","author":"Houghton","year":"2016","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1080\/01634372.2014.882466","article-title":"What is known about dementia care recipient violence and aggression against caregivers?","volume":"57","author":"Wharton","year":"2014","journal-title":"J. Gerontol. Soc. Work"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/13607860410001649635","article-title":"Behavioral symptoms of dementia: Their measurement and intervention. Escalation\/de-escalation patterns of behavioral symptoms of persons with dementia","volume":"8","author":"Woods","year":"2008","journal-title":"Aging Ment. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/inr.12180","article-title":"Ongoing challenges responding to behavioural and psychological symptoms of dementia","volume":"62","author":"Ostaszkiewicz","year":"2015","journal-title":"Int. Nurs. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jen.2013.05.014","article-title":"Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors","volume":"40","author":"Speroni","year":"2014","journal-title":"J. Emerg. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"70","DOI":"10.7748\/nr2010.07.17.4.70.c7926","article-title":"Development of a violence tool in the emergency hospital setting","volume":"17","author":"Wilkes","year":"2010","journal-title":"Nurse Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/inr.12106","article-title":"Unreported workplace violence in nursing","volume":"61","author":"Kvas","year":"2014","journal-title":"Int. Nurs. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3912\/OJIN.Vol9No03Man06","article-title":"Workplace violence in health care: Recognized but not regulated","volume":"9","author":"McPhaul","year":"2004","journal-title":"Online J. Issues Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/216507991306101004","article-title":"Exploring workplace violence among home care workers in a consumer-driven home health care program","volume":"61","author":"Nakaishi","year":"2013","journal-title":"Workplace Health Saf."},{"key":"ref_26","unstructured":"Australian Bureau of Statistics (2015). 6324.0-Work-Related Injuries, Australia, Jul 2013 to Jun 2014."},{"key":"ref_27","first-page":"1","article-title":"Employing a qualitative description approach in health care research","volume":"4","author":"Bradshaw","year":"2017","journal-title":"Glob. Qual. Nurs. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/nur.21768","article-title":"Characteristics of qualitative descriptive studies: A systematic review","volume":"40","author":"Kim","year":"2017","journal-title":"Res. Nurs. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_30","unstructured":"Dementia Collaborative Research Centre (2012). Behaviour Management: A Guide to Good Practice, UNSW."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1177\/0022185614541179","article-title":"Health and safety of homecare workers engaged by temporary employment agencies","volume":"57","author":"Quinlan","year":"2015","journal-title":"J. Ind. Relat."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/2165079915607500","article-title":"Measurement of workplace violence reporting","volume":"64","author":"Huang","year":"2016","journal-title":"Workplace Health Saf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.1547-5069.2009.01321.x","article-title":"Violence toward nurses, the work environment and patient outcomes","volume":"42","author":"Roche","year":"2010","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1037\/1076-8998.6.3.255","article-title":"Behind closed doors: In-home workers\u2019 experience of sexual harassment and workplace violence","volume":"6","author":"Barling","year":"2001","journal-title":"J. Occup. Health Psychol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1037\/1076-8998.9.3.206","article-title":"Aggression and violence against home care workers","volume":"9","author":"Bussing","year":"2004","journal-title":"J. Occup. Health Psychol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1037\/0021-9010.82.3.434","article-title":"Retaliation in the workplace: The roles of distributive, procedural, and interactional justice","volume":"82","author":"Skarlicki","year":"1997","journal-title":"J. Appl. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1111\/j.1365-2702.2008.02440.x","article-title":"Factors associated with the prevalence of violent behaviour among residents living in nursing homes","volume":"18","author":"Isaksson","year":"2009","journal-title":"J. Clin. Nurs."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/(SICI)1099-1166(199601)11:1<57::AID-GPS290>3.0.CO;2-Z","article-title":"Aggressive incidents towards staff by elderly patients with dementia in a long-stay ward","volume":"11","author":"Freyne","year":"1996","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1177\/1049732307313754","article-title":"Taking the hit: Focusing on caregiver \u2018error\u2019 masks organizational level risk factors for nursing aide assault","volume":"18","author":"Morgan","year":"2008","journal-title":"Qual. Health Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/j.1748-3743.2010.00226.x","article-title":"Perceptions and implications of violence from care home residents with dementia: A review and commentary","volume":"6","author":"Scott","year":"2011","journal-title":"Int. J. Older People Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3928\/0098-9134-19990401-05","article-title":"Violence against caregivers in nursing homes: Expected, tolerated and accepted","volume":"4","author":"Gates","year":"1999","journal-title":"J. Gerontol. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.socscimed.2011.10.037","article-title":"Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia","volume":"74","author":"Banerjee","year":"2012","journal-title":"Soc. Sci. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1037\/1076-8998.8.2.110","article-title":"Reducing the adverse consequences of workplace aggression and violence: The buffering effects of organizational support","volume":"8","author":"Schat","year":"2003","journal-title":"J. Occup. Health Psychol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1177\/0886260510383027","article-title":"Violence against teachers: Prevalence and consequences","volume":"26","author":"Wilson","year":"2011","journal-title":"J. Interpers. Violence"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/PTS.0b013e31818936e3","article-title":"Household-related hazardous conditions with implications for patient safety in the home health care sector","volume":"4","author":"Gershon","year":"2008","journal-title":"J. Patient Saf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1046\/j.1471-6712.2002.00052.x","article-title":"Incidence of violence towards staff caring for the elderly","volume":"16","author":"Bucht","year":"2002","journal-title":"Scand. J. Caring Sci."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Heponiemi, T., Kouvonen, A., Virtanen, M., V\u00e4nsk\u00e4, J., and Elovainio, M. (2014). The prospective effects of workplace violence on physicians\u2019 job satisfaction and turnover intentions: The buffering effect of job control. BMC Health Serv. Res., 14.","DOI":"10.1186\/1472-6963-14-19"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1071\/AH10874","article-title":"Occupational violence in general practice: A whole-of-practice problem, Results of a cross-sectional study","volume":"14","author":"Magin","year":"2011","journal-title":"Aust. Health Rev."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/438\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:52:47Z","timestamp":1760147567000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,27]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010438"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010438","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,27]]}}}