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Violence on Healthcare Staff

An EBP Literature Review
by

Travis Talley

on 10 November 2014

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Transcript of Violence on Healthcare Staff

Becoming cornered is a dangerous situation and not the ideal solution when trying to provide care to others!
But isolation is not what nursing is about!
Safety in numbers
Violence on nurses is more than whats on the surface!
Staff
Patient
The purpose of this literature review is to apply evidence based practice to the issue of workplace violence on healthcare workers.

Objectives
IOWA model
IOWA model overview
Violence on healthcare workers

Why: "up to 74% of healthcare workers experience violence of some form, (Thackery, 1987)."

Problem Based Issue: Acts of violence on staff is an increasing statistical trend.

Topic
Topic Evaluation

Alex Tam: PowerPoint/Slide Builder/Presenter

Kaitlin Wilson: APA Reconcile/Presenter

Virginia Hinton: Slide Builder/Presenter

Bennie Kowalski-RN: PowerPoint Builder/Presenter

Travis Talley: Team Leader, Prezi Builder, Collecting Articles, Creation of Binder, Team Work Load Distribution, Presenter
JCHS Research Class Team
The increasing trend of violence toward healthcare workers has the capability to affect staff ranging from mental fatigue to physical disability. A decrease in violence could reduce cost associated with; absenteeism from work, nursing burnout, and associated healthcare costs of physical injury.

This is a quality improvement project.
The Burning Question
Population: all healthcare workers

Intervention: research on effective violence reduction techniques

Comparison: currently employed practices

Outcome: decrease resulting mental and physical harm

Time: during patient care

PICO (T)
In violence prone settings, what are effective techniques to reduce harm to staff during patient care ,in addition to current policy and standards of care, that will result in a decrease in incidence and severity of violence on healthcare workers.
PICO(T)
Initial review of the literature:
Two strong current relevant studies (<5 years old)
Key word strategy: Nurs* safety, violence AND healthcare, Violence prevention, Staff safety, Saf*,
Ancestry search on (Thackery,1987) assessment instrument
(Thackery, 1987) Assessment Instrument was found to be very strong
Review of the Literature

Refinement:
-Constricted general theme because knowledge gaps

Expansion of Criterion:
-Knowledge Gaps
-Lack of High Quality Studies

Review of the Literature

A tool to display large summative data about articles.

Allows view of crucial data all at once.

5 studies for inclusion narrowed down with this tool.


Evidence Analysis/ Summary Tool
Evidence Critique Tool

Workplace violence: Serious nursing issue

International, non-gender, all races

Increase in violence trends

Plethora of factors

Up to 74% of all healthcare employees (Thackery, 1987 p. 57)

Stressors overcome coping ability

Introduction

Economic factors increase patient-nurse ratios

Currently reactively based

Knowledge Gaps :

Interventional effectiveness of alternative methods

Preventative Control Methods
Introduction Continued

The purpose of this study is to explore alternative methods to control violence and compare these methods to current policy and standards of care, in the management of aggression in the hospital setting, that would benefit all parties involved.

Purpose of the Project
A standard of definitions need to be developed.
Standardized up to date instruments of violence assessment need to be developed, and validated.
Study duplicability and transferability need high priority in design process.
More high quality studies need to be undertaken on this subject.
A muti-step systematic violence assessment and intervention model for all hospital settings needs creation and implementation.
Discussion
What did we learn from this project?
How to work together as a team to analyze articles and research data
Teamwork is a big part in preventing workplace violence and avoiding harm
Workplace violence is a problem and should be in the back of all healthcare worker's minds.
Workplace violence is something that can be avoided with proper knowledge and awareness.

Lessons Learned
Any questions?
Follow up?
Conduct the post-survey.


References
The IOWA model
Incorporates evidence based practice
Help identify problem-focused trigger/knowledge-focused trigger
Identify research evidence for clinical practice change
Highlights considering the entire healthcare system
Research within settings guiding practice decisions
Implement change & Monitor the outcomes
(Dontje, 2007, p.1)

Allen, D., & Tynan, H. (2000). Responding to Aggressive Behavior: Impact of Training on Staff
Members Knowledge and Confidence.
Mental Retardation, 38
(2), 97-104. Retrieved from ebscohost.com database.

Arnetz, J. E., & Arnetz, B. B. (2000). Implementation and evaluation of a practical intervention
programme for dealing with violence towards health care workers.
Journal of Advanced Nursing, 31
(3), 668-680. Retrieved from ebscohost.com database.

Dontje, K. J., 2007. Evidence-based practice: Understanding the process.
Disclosures Topics in
Advanced Practice Nursing eJournal, 7
(4). Retrieved from http://www.medscape.com/viewarticle/56 7786_4

Hahn, S., Zeller, A., Needham, I., Kok, G., Dassen, T., & Halfens, R. J. (2008). Patient and visitor
violence in general hospitals: A systematic review of the literature.
Aggression and Violent Behavior, 13
(6), 431-441.

Kate, K., Chiung-Jung, W., & M., C. A. (2010). Interventions for preventing and managing Patients
Admitted to an Acute Hospital Setting: a Systematic Review.
Worldviews on Evidence-based Nursing
, p. 1-28. Retrieved from ebscohost.com database.

Matrin, T., & Daffern, M. (2006). Clinical perceptions of personal safety and confidence to
manage inpatient aggression in a forensic psychiatry setting.
Journal of Psychiatry and Mental Health Nursing, 13
, 90-99.

Polit, D., & Beck, C. (2014).
Essentials of nursing research: Appraising evidence for
nursing practice.
(8 ed.). Philadelphia: Lippincott, Williams & Wilkins.

Thackrey, M. (1987). Clinician confidence in coping with patient aggression: Assessment and
enhancement.
Professional Psychology: Research and Practice, 18
(1), 57.



Independent Variable (IV)
-Effective violence reduction techniques

Dependent Variable (DV)
-Healthcare worker harm



IV and DV

Method
Review of literature for best evidence
Management of aggression in the hospital
1 RCS, 2 systematic reviews
1 pivotal instrument design
1 mixed method, 1 qualitative study
Study 1
Judith Arnetz randomized control study
Practical intervention program dealing with violence
Violence Incident Form (VIF) event registration method (Arnetz, 2000 p.670)
Group staff analysis and debriefing
1203/1560(77%) returned surveys (Arnetz, 2000 p.671).
The VIF form Cronbach's alpha of 0.80 (Arnetz, 2000 p.671)
Study 2
Sabine Hahn systematic review of literature
patient visitor violence in general hospital
26 crossectional retrospective
14 investigative experiences
6 medical doctor experiences
6 focused on all health care staff (Hahn, 2008 p.14).
Systematic reviews hold generally the highest validity and reliability ratings.
Study 3
David Allen qualitative study
Impact of training on knowledge and confidence.
Pre/post training questionnaire,(Allen, 2000 p.99)
Instrument: modified (Thackery, 1987).
Cronbach's alpha of 0.88 ,(Allen, 2000 p.100).
Study 4
T. Martin, mixed method study
safety and confidence to manage patient aggression (Martin, 2006)
survey staff training and confidence correspondence (Martin, 2006 p.92)
Instrument: modified Thackery (1987)
Psychometric properties questionnaire unknown, first application (Martin, 2006 p.92).
Study 5
Kate Kynoch, Systematic review
Interventions for preventing and managing aggressive patients, (Kynoch, 2010)
5 stage process narrowed 954 studies to19, (Kynoch, 2010 p.6)
Further narrowed by two independent reviewers
Using standardized critical appraisal instrument, Joanna Briggs Institute, (Kynoch, 2010 p.6)
10 studies for inclusion and review, (Kynoch, 2010 p.6)
Systematic reviews have highest validity and reliability
Results and Analysis

Results and Analysis Study 1
Judith Arnetz, Randomized Control Study
Intervention Program for Dealing with Violence
Chi-square, ANOVA, and programs BMDP (1993), and SPSS (1995) (Arnetz, 2000 p.671).
Baseline= 83% exposed to violence at work, (Arnetz, 2000 p.671)
684 VIF incidents registered (Arnetz, 2000 p.672).
Follow up survey response 82% intervention groups (Arnetz, 2000 p.672)
77% felt workplaces had better managing violent incidents, (Arnetz, 2000 p.673)
Results and Analysis
Study 2
Sabine Hahn systematic review
Patient visitor violence in general hospital
Healthcare employees, high risk for experiencing violence, (Hahn, 2008 p.15).
11/31 studies: minimal/no definition of violence, (Hahn, 2008 p.14).
54% of ICU nurses experienced violence, (Hahn, 2008 p.16).
Unclear about shift/time relationship, (Hahn, 2008 p.17).
Patients aggressive during first 2-3 days, (Hahn, 2008 p.17)
Categorically, nurse = highest risk, (Hahn, 2008 p17)
Occupational Therapists, Laboratory Technicians, Physical Therapists, Midwives < risks, (Hahn, 2008 p.18).
Results and Analysis Study 3
David Allen studied staff responce to aggression ,(Allen, 2000)
Implications of training on knowledge & confidence ,(Allen, 2000)
Aggression pre/post training confidence were 49.7 and 74.5 respectively,(Allen, 2000 p.101).
Results and Analysis Study 4
T. Martin conducted safety/confidence to manage patient aggression (Martin, 2006)
Aggression management training provided confidence with aggressive clients (Martin, 2006)

Themes Identified:
Proactive strategies de-escalated aggression (Martin, 2006 p.96
Availability of adequate staff/Teamwork (Martin, 2006 p.96
Electronic duress response system (Martin, 2006 p.96
Environment and building design (Martin, 2006 p.96
Experience and skill of clinicians (Martin, 2006 p.96
Results and Analysis Study 5
Kate Kynoch's, Systematic review
Interventions preventing and managing aggressive patients, (Kynoch, 2010)
Overall low rate of minor complications, (Kynoch, 2010 p.20
(6)Chemical restraint studies revealed Droperidol/Midazolam faster sedation, (Kynoch, 2010 p.19)
No gold standard rapid tranquillization in psych/ED, (Kynoch, 2010 p.22)
No studies of sufficient quality evaluated multiple interventions for aggression management, (Kynoch, 2010 p.21)
No studies investigated acute care settings, (Kynoch, 2010 p.21).
Audience Questions
Travis Talley, SN
Bennie Kowalski, RN
Virginia Hinton, SN
Alex Tam, SN
Kaitlin Wilson, SN


Violence on Healthcare Workers
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