Defining the Role and Occupational Health Issues of Patient Sitters

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Abstract Patient sitters are healthcare workers responsible for “constant observation” of patients at risk for harming themselves and others (e.g., suicidal, at risk for falling, agitated, violent, withdrawing from drugs/alcohol). This often requires them to manage difficult patients and situations on their own in isolation for 8- to 12-hour shifts. Although healthcare organizations rely heavily on patient sitters, there is consensus in the clinical-based literature that this job is poorly defined, and that workers in this role are poorly trained and prepared to meet the requirements of their job. Further, numerous studies have examined the effectiveness of patient sitters on patient outcomes (e.g., patient fall prevention); however, a recent systematic review identified only one study in the past decade that pertained to worker health and safety issues among patient sitters. While healthcare workers are known to be at high risk for numerous occupational exposures and outcomes (e.g., musculoskeletal injury, exposure to droplet/airborne pathogens, bloodborne pathogens), no studies have examined these types of exposures/outcomes in patient sitters. Patient sitters serve a critical role in patient care, yet, they are poorly defined in the clinical-based literature, and are essentially absent in the occupation health literature. To address these gaps, we aim to define the role of the patient sitter in the acute care pediatric and adult hospital settings, describe the types of training and continuing education that patient sitters receive and need, and examine the occupational health and safety issues that patient sitters encounter. We propose to conduct a cross-sectional, mixed methods study of patient sitters and hospital leaders. In collaboration with the Texas Hospital Administration (THA), we will invite leaders that oversee their Patient Sitter program/workers (n=430 Texas hospitals) to participate in an anonymous online survey about the role of the patient sitter in their hospitals, as well as hospital procedures and policies that pertain to these workers. Among those that respond, we will request access to conduct an anonymous online survey among their patient sitters with the goal of recruiting 1,000 sitters, with a mix from pediatric and adult acute care hospitals. The development of the patient sitter survey will be informed by the hospital leader survey findings, as well as focus group discussion findings among a subset of patient sitters from the participating hospitals. The sitter survey will ascertain details about job responsibilities, training, occupational safety and health issues, and organizational support. Findings from this proposed work will place sitters into the occupational literature where they can be appropriately defined and considered in the context of occupational health and safety prevention efforts.