According to the World Health Organization, workplace violence is “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation” . Workplace violence, and particularly client-initiated violence, is a serious problem for mental health workers, as they represent one of the most at-risk populations . Rates of patient aggression in psychiatric settings range from 0.07–0.25 aggressive incidents per bed per year . A literature review from Piquero, Piquero, Craig, and Clipper  showed that between 14% and 61% of mental health workers had been victimized by violent acts, mainly due to aggressive patient behaviours . However, the study-specific variations regarding the measure of prevalence (i.e., prevalence period, survey designs) render efforts to establish largely based prevalence rates challenging .
The consequences of violent acts are numerous, whether they be on victims (and on their relationship with patients), on organizations, or on society. More precisely, a systematic literature review of the impact of workplace violence in healthcare settings conducted by Lanctôt and Guay , identified 68 studies that address different types of potential consequences. Among these, 47 studies identified several psychological consequences for workers, 27 reported physical consequences, 25 revealed an impact on emotional well-being, 47 highlighted consequences related to work functioning, 10 showed a negative impact on the quality of the relationship and care with patients, and four studies reported financial and social consequences.
Several studies in the healthcare sector have established a positive association between workplace violence and psychological distress [8,9,10,11], and between workplace violence and a lesser level of confidence in one’s own abilities to cope with patient aggression [12,13]. Martin and Daffern  highlighted the importance for mental healthcare workers, who are at high-risk of violence, to have confidence in their capacities to work with aggressive patients. Additionally, the perceived severity of aggressive behaviors may decrease following training, which could be a sign of an increased confidence to manage these events .
1.1. Prevention through Education and Training Programs
Within the literature, it is frequently recommended that employers implement education and training programs for high-risk workers in order to prevent workplace violence [3,5,6,15]. These programs generally aim to help workers develop skills to better recognize and react to violent situations, and to better cope with their consequences. They “comprise any of a broad range of techniques to enhance knowledge and understanding of organisational policies and procedures, legal responsibilities, and risk assessment and control strategies” . Wang et al.  reviewed 35 studies conducted among nurses that assessed the effectiveness of workplace violence education and training programs. Their results showed that the majority of these programs decreased violence, improved knowledge and confidence, and increased tolerance and positive attitude change. They also identified several programs that had no influence on violence or that increased violence. In addition, a review of literature specific to acute hospital settings was conducted by Heckemann et al.  and showed that all nine education and training programs reviewed lead to increased confidence as well as improved attitude, skills, and knowledge. However, these authors noted no significant change in the incidence of violent acts in the workplace. Based on 38 studies conducted in mental health settings, Price, Baker, Bee, and Lovell  found that the greatest benefits of education and training programs appear to be de-escalation-related knowledge, confidence in managing aggression, and de-escalation performance. However, they could not draw conclusions about the impact of training on assaults, injuries, containment, and organizational outcomes, owing to the low quality of evidence and conflicting results.
The bulk of the literature on education and training programs for the prevention of workplace violence is limited by the short duration of evaluation periods. Among the cited reviews [5,16,17,18], the majority of the studies did not provide information on the duration of the evaluation period, and only four were based on a follow-up period of one year or more. Therefore, literature regarding intermediate and long-term effects of these programs is scarce.
1.2. Effectiveness of Education and Training Programs for Preventing Violence in the Healthcare Sector
Studies on education and training programs aimed at preventing workplace violence towards employees generally conclude that these are effective. However, measures are generally obtained immediately following the training or after a very short time period [5,16,18]. The current study investigates the effectiveness of the Omega training program in both a short-term and follow-up period. To date, only one study has evaluated the impact of this program, and shows that participants increased their knowledge on how to better prevent workplace violence . No empirical studies have yet been conducted to assess the impact of the training program on the psychological health of participants or on the perceived risk of violence. Given that this program is widely used in Canada, it is necessary to assess its efficiency based on scientific facts and to develop recommendations.
1.3. The Omega Education and Training Program
The Omega program aims to prevent and minimize workplace aggression directed toward healthcare workers by improving the knowledge, attitudes, and skills of participants when facing verbal and physical aggression by patients. It was created in 1999 by the Health and Social Services section of the Agency for Health and Safety at Work of the province of Quebec, Canada . Three counselors from the governmental Agency for Health and Safety at Work of the province of Quebec, as well as six workers from a mental health institute specialized in violence issues, designed the program over a two-year period. During this period, observational analyses and interviews were conducted in three psychiatric hospitals in order to identify the expertise of experienced security workers in solving at-risk and violent situations. Moreover, at the time the program was developed (i.e., 1996), no specific education and training program dedicated to psychiatric hospitals was available in the province of Quebec. Since its creation, the program has been implemented in numerous hospitals, local community service centres, youth protection centres, and community organizations . Between 1999 and 2015, the Omega program was implemented amongst 47,408 workers in Canada (data provided by the governmental organization responsible for the program).
The Omega program is taught by peer trainers (security agents). It lasts four days, and seeks to teach participants the skills and intervention methods necessary to ensure their safety and that of their patients in situations of aggression . On the first day, participants are taught the fundamental values and principles of Omega. The four core values are respect, professionalism, accountability, and security. The five principles are to protect oneself, to assess the situation, to predict behavior, to take the time, and to focus on the person. The second day focuses on a pacification approach and on a grid for classifying behaviors and levels of dangerousness of potentially aggressive individuals. The third day addresses the utilized tools for the intervention pyramid (i.e., behaviors to adopt according to the behavior). The last day is focused on post-incident reports and on feedback regarding the three other days. Practical exercises are conducted every day. For each of the principles, the training program teaches specific verbal, psychological, or physical intervention techniques for frequently-encountered situations. Levels of dangerousness include emotional tension, conditional cooperation, refractory behavior, destructive behavior, psychological intimidation, active resistance, physical aggression, serious assaults, and exceptional threats. Teamwork in facing situations of violence is also highly valued and integrated in the training. Participants are taught to resolve aggressive crisis situations with an approach that is centered on the experiences of the individual in question. Seven levels of interventions are classified in an intervention pyramid ranging from mitigation (i.e., resolving the aggressive crisis situation or the acute crisis with an approach focused on the safety of the patient) to physical intervention (i.e., last resort intervention, used when the patient or client has imposed an act of protection or control).
The training also provides the necessary tools to complete a post-incident report. This report is designed to assess the relevance and effectiveness of crisis management interventions after-the-fact through team feedback and monitoring.
1.4. The Present Study
The purpose of this study was to examine the effect of the Omega education and training program, after the training and at a follow-up, on employee psychological well-being, and more precisely on their psychological distress, on their confidence in their skills, and on their perceived level of exposure to different forms of violence.
This study was approved by the Ethics committee of the Institut Universitaire en Santé Mentale de Montréal (IUSMM; Montreal Mental Health University Institute, Montreal, QC, Cananda).
Between January and October 2012, 105 employees of the high-risk units of the IUSMM (i.e., intensive care, emergency department, and security) were offered to participate in a training program to better prevent and manage situations of aggression in the workplace. The IUSMM is one of the two major institutes dedicated to mental health in the city of Montreal. The total number of employees in the IUSMM is 1984, 105 of which worked in the high-risk units. The total number of admissions is about 1880 each year. In 2012, 156 acts of violence were officially reported to the employer. At the time of the study, there was no other education and training program offered.
On the first day of the program, the employees were invited to participate in the current study. They were informed of the longitudinal design of the study (with three measurement times), the confidential aspect of the research and the monetary compensation of $25 for each completed assessment. Eighty-nine of the 105 solicited employees participated at the first time of measurement, which indicates a response rate of 85% at Time 0. Of these, 80 and 63 participants completed the short-term (Time 1) and follow-up (Time 2) posttest questionnaires, which represents retention rates of 85% and 70.9%, respectively. For Time 1 and Time 2, participants were mailed the questionnaire via the internal mail system 90 days and 420 days after their training. Participants were invited to return the envelopes within two weeks. Questionnaires were received 109 days and 441 days on average after the training. A follow-up letter was mailed to reach those who had not yet forwarded their response two weeks following each measurement time. Participants were informed that they could complete the questionnaire during their working hours. Motives for documented dropouts were as follows: non-defined personal reasons (eight cases), absence for vacations (three cases), disease (two cases), and sick leave (one case).
2.2. Study Instruments
A questionnaire package was created for the purpose of this study. Instruments were standardized scales (i.e., psychological distress, confidence in coping) or were developed specifically for the present study (i.e., level of exposure to different forms of violence). The questionnaire was administered in paper-and-pencil form.
2.2.1. General sociodemographics
The questionnaire package included items about general demographics including sex, age, marital status, work unit, work shift, and employment type and status.
2.2.2. Psychological distress
Psychological distress was measured by the K6 scale developed by Kessler et al. . Psychological distress was assessed based on the frequency with which participants had experienced anxiety and depression symptoms during the last month. The instrument consists of six items rated on a five-point scale ranging from “never” to “all the time”. A higher score is indicative of greater psychological distress. The Cronbach alpha was 0.76 in this study. A score of 13 or more indicates a risk for severe psychological distress.
2.2.3. Level of exposure to different forms of violence
Three scales were designed to evaluate perceived exposure to tensions, minor violence, and serious violence, respectively, during the last three months. These items referred specifically to the definition of various levels of violence defined in the Omega training. Participants were told: “This section is about your personal experience of specific events and their frequency in the intensive care and emergency units. For each of the following statements, please assess the frequency with which these events occurred during the last 3 months.” Each scale consists of three items, each of which was assessed on a six-point scale from “never” to “everyday”. An example item for tensions is: “A patient is anxious, crying or has isolated himself/herself”; for minor violence: “A patient throws or breaks objects”; for serious violence: “A patient commits acts that might cause injury or death”. The Cronbach alphas were 0.85, 0.78, and 0.77. No standardized measures were available.
2.2.4. Confidence in coping with patient aggression
Confidence in coping with patient aggression was measured with the scale developed by Thackrey . The instrument consists of 10 items rated on an 11-point scale. Ranges vary depending the question from “very uncomfortable”, “very poor”, “very unable”, “very unsafe”, and “very ineffective” to “very comfortable”, “very good”, “very able”, “very safe”, and “very effective”. A high score is indicative of strong confidence in dealing with patient aggression. The Cronbach alpha was 0.96 in this study. This scale was found to be a useful instrument for evaluations on the group level when used as a pre- and post-test measure . No standardized measures were available.
Data analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY, USA) and using an alpha of 0.05. Repeated-measures ANOVAs were performed to estimate the differences in participants’ scores between the pretests and the two posttests. We conducted bivariate analysis and checked for potential confounding variables (sex, age, unit of work, type of employment, or work shift), for which only statistical significant changes are presented. Finally, Cohen’s d effect sizes were calculated after controlling for correlations between measurement times to determine the extent of the significant results. Criteria for Cohen’s d effect sizes proposed by Kotrlik, Williams, and Jabor  were used and were as followed: small (d ≥ 0.10), medium (d ≥ 0.30), and large (d ≥ 0.50).
The purpose of an evaluation essay is to present an opinion or viewpoint on a subject or body of work. It should firstly provide a summary of the article in question, then using a thorough, well structured argument the writer presents a point-of-view supported with examples and evidence. By nature this essay bears many similarities to the persuasive essay, only is designed to display a more balanced argument
The first step in writing an evaluation essay is to provide a judgment asserted through a clear thesis. A good thesis statement determines exactly the focus of your essay and aids the reader in understanding what the essay is all about. Furthermore, it presents the point-of-view you are taking and hereafter each paragraph should work towards asserting this point-of-view to the reader. Consider the examples below, it is obvious which one provides the clearest definition of what the essay is about, and the argument it will present:
A: Abbey Road is an album by the Beatles.
B: Through the balance of classic song writing, experimentalism and the harnessing of musical technology, The Beatles created the masterpiece that is Abbey Road.
It is clear that B is the most successful in summarizing the subject matter evaluated in the essay, whilst also displaying the writer’s opinion and the stance the essay will take throughout the main body.
Writing an evaluation essay
For your evaluation essay to be successful in putting your point across you need a convincing argument. It is important to thoroughly research the subject matter or have comprehensively read and digested the body of work in question. For your essay to sound convincing it is essential that you know what you are clear and confident in the subject matter you are covering.
If the evaluation essay is to be successful you must back up your viewpoints using evidence. For example, if you are evaluating the faults of a text you must back up your observations with facts and quote from the source material to verify your statements. To further demonstrate your point you may also wish to compare your subject matter to a separate body of work to compare or contrast where its strengths and weaknesses lie.
An evaluation essay should show impartiality and therefore present a balanced argument. If a writer appears biased towards a subject then the argument is ultimately less convincing. As a result the essay will fail to persuade or convince the reader to agree with the ideas or views the writer is working to establish.
The evaluation essay will require a conclusion which summarizes the points made during the main body. It is important that your argument has been logically structured throughout; that each point made leads fluently on to the next and seamlessly through to the conclusion.
You should provide concrete and secure closure to your argument by ultimately leaving the reader absolutely convinced by your evaluation and each point should have in turn worked towards proving the viewpoints of your thesis justified and correct, through a fair and unbiased analysis.
Gender differences and biases have been a part of the normal lives of humans ever since anyone can remember. Anthropological evidence has revealed that even the humans and the hominids of ancient times had separate roles for men and women in their societies, and this relates tot the concepts of epistemology. There were certain things that women were forbidden to do and similarly men could not partake in some of the activities that were traditionally reserved for women. This has given birth to the gender role stereotypes that we find today. These differences have been passed on to our current times; although many differences occur now that have caused a lot of debate amongst the people as to their appropriateness and have made it possible for us to have a stereotyping threat by which we sometimes assign certain qualities to certain people without thinking. For example, many men are blamed for undermining women and stereotyping them for traditional roles, and this could be said to be the same for men; men are also stereotyped in many of their roles. This leads to social constructionism since the reality is not always depicted by what we see by our eyes. These ideas have also carried on in the world of advertising and the differences shown between the males and the females are apparent in many advertisements we see today. This can have some serious impacts on the society as people begin to stereotype the gender roles in reality.
There has been a lot of attention given to the portrayal of gender in advertising by both practitioners as well as academics and much of this has been done regarding the portrayal of women in advertising (Ferguson, Kreshel, & Tinkham 40-51; Bellizzi & Milner 71-79). This has led many to believe that most of the advertisements and their contents are sexist in nature. It has been noted by viewing various ads that women are shown as being more concerned about their beauty and figure rather than being shown as authority figures in the ads; they are usually shown as the product users. Also, there is a tendency in many countries, including the United States, to portray women as being subordinate to men, as alluring sex objects, or as decorative objects. This is not right as it portrays women as the weaker sex, being only good as objects.
At the same time, many of the ads do not show gender biases in the pictures or the graphics, but some bias does turn up in the language of the ad. “Within language, bias is more evident in songs and dialogue than in formal speech or when popular culture is involved. For example, bias sneaks in through the use of idiomatic expressions (man's best friend) and when the language refer to characters that depict traditional sex roles. One's normative interpretation of these results depends on one's ideological perspective and tolerance for the pace of change. It is encouraging that the limited study of language in advertising indicates that the use of gender-neutrality is commonplace. Advertisers can still reduce the stereotyping in ad pictures, and increase the amount of female speech relative to male speech, even though progress is evidenced. To the extent that advertisers prefer to speak to people in their own language, the bias present in popular culture will likely continue to be reflected in advertisements” (Artz et al 20).
Advertisements are greatly responsible for eliciting such views for the people of our society. The children also see these pictures and they are also the ones who create stereotypes in their minds about the different roles of men and women. All these facts combine to give result to the different public opinion that becomes fact for many of the members of the society. Their opinion and views are based more on the interpretation they conclude from the images that are projected in the media than by their observations of the males and females in real life. This continues in a vicious circle as the media tries to pick up and project what the society thinks and the people in the society make their opinions based upon the images shown by the media. People, therefore, should not base too much importance about how the media is trying to portray the members of the society; rather they should base their opinions on their own observation of how people interact together in the real world.
Artz, N., Munger, J., and Purdy, W., “Gender Issues in Advertising Language”, Women and Language, 22, (2), 1999.
Bellizzi, J. A., & Milner, L. “Gender positioning of a traditionally male-dominant product”, Journal of Advertising Research, 31(3), 1991.
Ferguson, J. H., Kreshel, P. J., & Tinkham, S. F. “In the pages of Ms.: Sex role portrayals of women in advertising”, Journal of Advertising, 19 (1), 1990.