Workplace Violence Prevention Program Research Articles

A workplace violence prevention program targeting high-risk patients in emergency departments.

Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool. A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed. Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p=0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p=0.418). The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.

Addressing the Issue of Potential Workplace Violence Events for Sonographers and Vascular Technologists

Workplace violence is considered the act or threat of violence, exemplified by verbal threats and or physical threats perpetrated to an employee in the workplace. As part of the ongoing survey research being conducted, workplace violence events (WVEs), specific to sonographers and vascular technologists, were explored. These threats were further categorized based on the four types of WVE proposed by the Injury Prevention Research Center in 2001. Qualitative analysis of this survey data and voluntary comments, provided by study participants, were identified as condescending behavior, and being bullied as major workplace concerns. Further qualitative assessment of the comments resulted in identifying the added risk of Customer/client (Type 2) and Worker-on-worker (Type 3) WVEs, which are considered forms of verbal abuse. This information needs to be considered by each sonographer and vascular technologist and whether it is an issue in their workplace. In addition, a comprehensive workplace violence prevention program is advocated to address workplace incivility and promote worker health, safety, and well-being. Providing annual training is not enough, as workers need to have policies and resources readily available to address WVEs when they occur. These policies and resources should specifically address WVEs perpetrated by patients and co-workers.

Violence in the healthcare workplace.

Healthcare workers experience a disproportionate frequency of workplace violence. Identifying commonalities among incidents of workplace violence provides an opportunity for change to prevent and mitigate future violence. Despite a continued decline in overall workplace violence, the rate of violence in the healthcare sector is steadily rising. While healthcare workers make up 13% of the workforce, they experience 60% of all workplace assaults. Environmental, structural, and staffing issues may all contribute to the increased rates of workplace violence affecting healthcare workers. Comprehensive proactive workplace violence prevention programs can significantly reduce the frequency of violence and the negative impact on employees and institutions. Analyzing the factors that contribute to violence in the healthcare workplace provides the potential to mitigate these risks and reduce episodes of violence.

Evaluating a Workplace Violence Management Program and Nurses' Confidence in Coping With Patient Aggression.

The purpose of this study was to evaluate nurse confidence in coping with patient aggression after implementing a workplace violence prevention program that includes management and postevent support. Patient aggression toward nurses is increasing, leading many healthcare organizations to develop workplace violence prevention programs. This cross-sectional study was conducted at a large healthcare system in the Midwestern United States. Clinical nurses caring for adult patients across the care continuum ≥51% of the time were invited to participate. In situ simulation plus standard training did not have a significant impact on confidence after controlling for the year education occurred; however, nurses completing training in 2022 had significantly higher confidence than nurses completing training in 2019. Use of the Violence Assessment Tool and participating in a post-control alert debriefing were also associated with significantly higher confidence. Factors other than education may influence nurses' confidence in coping with patient aggression.

Prevalence and factors associated with workplace violence in a tertiary healthcare facility in Nigeria.

Healthcare workers globally are at an increased risk of workplace violence. Adverse effects such as physical injury, reduced quality of care to patients and lower productivity with associated costs to employers occur. Non-reporting hinders the implementation of effective prevention. This study aimed to assess the prevalence, reasons for non-reporting of workplace violence, and knowledge of prevention prior to designing intervention strategies in the study location where there is a paucity of research on this issue. This cross-sectional study was conducted at a Teaching Hospital in Abakaliki, Ebonyi State, for 4 weeks in 2020 among 205 employees. The hospital was stratified into Clinical, Nursing Services, Pharmacy, Laboratory, and administrative divisions; proportionate allocation and random sampling were used to select the allocated samples. A structured questionnaire was used to collect data. Descriptive statistics determined the measures of central tendencies and dispersion, while bivariate analysis of the variables was done using Pearson's Chi-Square test. Statistical significance was set at p ≤ 0.05 with a confidence level of 95%. The mean age of the participants was 39.1 ± 7.8 years. The prevalence of workplace violence was 70%. The most common reason for non-reporting was complexities and time-consuming reporting procedures (26.5%) followed by fear of reprisal on career (22.4%). The proportion of respondents with good knowledge of workplace violence prevention strategies was high (69.8%). Gender (p = 0.03), work setting (p = 0.006), previous workplace violence training (p = 0.005) and knowledge of workplace violence preventive strategies (p = 0.04) had statistically significant associations with experience of workplace violence. The high prevalence of workplace violence suggests a need for a workplace violence prevention program which should include a simple process of reporting and training. The improved awareness from previous training may account for the significant association with workplace violence.

Violent Event Severity Tool for Reporting Violent Incidents.

To explore the usefulness of the Violent Event Severity Tool (VEST). The Joint Commission and many governing bodies require establishing workplace violence prevention programs in hospitals. Inconsistent processes have hampered the efficacy evaluation of such programs for collecting and reporting violence. The VEST was developed as a standardized tool for capturing violence data. Ninety-six healthcare workers attending the 2022 Magnet® conference completed the survey. The VEST includes 6 types and 4 intensities of violent incidents. Most participants reported that the VEST is easy to use (79%), relevant (85%), and useful (85%). Fewer than half were satisfied with their incident report filing processes. Only 38% of participants experiencing grade 1 physical assault filed an incident report, whereas 70% and 100% experiencing grades 3 and 4 physical assaults filed. The VEST appears to be a useful and relevant tool for consistent collection and reporting of various violence types and severities.

A health system's journey to preventing workplace violence: Use of multidisciplinary teamwork to unify efforts across a health system.

Workplace violence (WPV) is known to threaten the safety of patients and staff. In 2018, a wellness survey showed many employees had not received training on WPV prevention and felt unprepared to manage aggression. The health network's leaders knew they needed to take action. From various multidisciplinary committees, the leaders were able to create a comprehensive WPV prevention program. Some of the highlights of this program include forming a centralized security department, codes of conduct, and crisis response process, adopting tools to predict violence, and providing a range of education. Data from WPV events showed the health network had a statistically significant reduction in WPV events from 2020 to 2021. However, WPV events increased in 2022. This increase in 2022 mirrors national trends in WPV. There are a number of factors that may have impacted this increase. Regardless, the leaders at the health network are dedicated to continuously improving the WPV prevention program. Some of the ongoing projects include improving data collection methods and building a long-term notification for highly violent individuals. This WPV prevention program relies on the commitment of its multidisciplinary team members and focuses on taking care of patients while also prioritizing the wellness of the staff.

Management staff's perspectives on intervention strategies for workplace violence prevention in a tertiary health facility in Nigeria: a qualitative study.

Health workers have increasingly become victims of workplace violence. However, negligible action has been given to developing workplace violence (WPV) prevention programs in hospital settings in low-middle-income countries. An effective workplace violence prevention program is crucial for preventing violence and managing the consequences of incidents. This study assessed management staff perspectives on intervention strategies for workplace violence prevention in a tertiary health facility in Nigeria. A qualitative study design was employed to explore the intervention strategies for preventing and managing workplace violence at a tertiary health facility in southeast Nigeria. Six focus group discussions were conducted with thirty-eight management-level staff. The interview transcripts were manually coded according to six predefined constructs of workplace violence: creating interdisciplinary harmony and WPV experiences, causes, prevention, program/policy contents, and implementation strategies. A manual thematic analysis approach was adopted, and the results were presented as narratives. The findings revealed recognition, welfare, administrative control, and security as vital strategies for the WPV prevention program. The participants agreed that unanimity among staff could be promoted through respect for all cadres of staff and for people's perspectives (creating interdisciplinary harmony). Assaults and staff intimidation/victimization (experiences), attributed to unethical/poor health workers' behaviour and ethnic discrimination (causes), were viewed as preventable by ensuring patients'/caregivers' welfare through respectful and timely care and staff's welfare through incentives/remunerations and discouraging intimidation (prevention strategies). Furthermore, the staff expressed that the WPV program should employ administrative controls, including instituting WPV policy/unit, codes of ethics, and standard operating procedures across all workplace facets (program/policy contents), which should be implemented through awareness creation, enforcement of sanctions, and provision of appropriate and adequate security presence in the hospital (policy implementation strategies). Respect, patient/staff welfare, administrative control, and security are strong mechanisms to prevent workplace violence in tertiary hospitals. Hospital management should institutionalize workplace violence prevention programs/policies and ensure compliance.

Workplace Violence in Healthcare Settings: A Scoping Review of Guidelines and Systematic Reviews.

Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses' Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews (n = 33) were grouped into five main categories: violence toward nurses (n = 10); violence toward healthcare workers in general (n = 8); violence in the emergency department (n = 5); violence related to mental health (n = 5); and measurement related to workplace violence (n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.

Exploring Jordanian emergency registered nurses’ experiences of workplace violence: A phenomenological study

BackgroundWorkplace violence against emergency nurses is an alarming hazard in Jordan, as it is globally. There is no prior research exploring the experiences of workplace violence against Jordanian emergency nurses. This study aimed to investigate Jordanian emergency registered nurses’ lived experiences of workplace violence from their patients or relatives while working. MethodA descriptive phenomenological study was conducted using Colaizzi’s data analysis method. Twelve emergency nurses participated in this study and were recruited via two Facebook groups using purposeful sampling. ResultsFour themes emerged from the analysis of violence in the emergency department revealed in this phenomenological study: (1) feeling overwhelmed that violence is so common, (2) ambivalent feelings toward patients and their families, (3) The feeling of inadequacy in handling violent situations, and (4) nurses’ suffering. DiscussionThe findings of this study have practical implications for in-service workplace training programs and may be used to inform potential changes to policies and legislation designed to establish a safer emergency department environment for nurses, patients and their relatives/visitors. ConclusionThe findings can help policymakers, healthcare leaders, and managers better understand the consequences of workplace violence to advocate for and establish workplace violence prevention programs and strategies to support nursing staff who have experienced these events.

De-escalation Training as Part of a Workplace Violence Prevention Program.

Workplace violence, including verbal and physical abuse, is escalating nationwide. As healthcare workers try to enforce COVID-19 prevention policies and practices, this phenomenon is exacerbated. De-escalation training is a method to prepare nurses through increased situational awareness, leading to early recognition and improved coping and confidence in dealing with aggression. Outcomes are presented, suggesting education of nurses may have a positive influence on the number of security calls and incident reports.

Effects of Integrated Workplace Violence Management Intervention on Occupational Coping Self-Efficacy, Goal Commitment, Attitudes, and Confidence in Emergency Department Nurses: A Cluster-Randomized Controlled Trial.

Patient and visitor violence (PVV), the most prevalent source of workplace violence, is largely ignored, underreported, and a persistent problem in emergency departments. It is associated with physical injuries, psychological distress, and occupational stress in nurses. A randomized controlled trial was conducted in Taiwan from January to December 2020. This study aimed to test the efficacy of an integrated Workplace Violence Prevention and Management Training Program on PVV in 75 emergency department (ED) nurses from a hospital. Cluster sampling was used because the policy of subdivision strategy was enforced during the COVID-19 pandemic. ED nurses received either the intervention or 1-hour in-service class. Data were collected from questionnaires. Data were analyzed mainly by the repeated measure analysis of variance and generalized estimating equations. The intervention had positive effects on developing stronger goal commitment, improving occupational coping self-efficacy, increasing confidence in ability to deal with violent situations, and modifying attitudes toward the causes and management of PVV in ED nurses (p < 0.05). The marginal R2 of the generalized estimating equation model for goal commitment, occupational coping self-efficacy, confidence, attitudes toward aggression in ED and aggressive behavior variables was high as 0.54 (p < 0.001), 0.45 (p < 0.001), 0.58 (p < 0.001), 0.29 (p < 0.05), and 0.72 (p < 0.001), respectively. These study models could effectively predict changes in the mean values. The benefit was driven by the effect of the intervention in ED nurses. Thus, the intervention, when applied in conjunction with routine in-service class, could exert synergistic improvements on outcomes measured in nurses.

Psychological Workplace Violence and Health Outcomes in South Korean Nurses.

Workplace violence (WPV) and its health consequences should continue to be investigated to foster a healthy and safe working environment, which may reduce nurse staff turnover and improve nurse staff shortages. This study aimed to address the gap in understanding WPV in non-western nurses by examining the relationship between psychological WPV experience, psychological well-being, subjective job stress, and presenteeism among South Korean nurses. This cross-sectional study used data from the fifth Korean Working Conditions Survey (KWCS), and 477 nurses were analyzed. For the analysis, selected variables were extracted from the KWCS through a review of the existing literature. In the analysis, we included psychological WPV experiences, such as verbal abuse, unwanted sexual attention, threats, and/or humiliating behaviors over the past 1 month. We measured health outcomes including nurses' psychological well-being, subjective job stress, and presenteeism. Psychological WPV within the previous month was experienced by 11.1% of the participants. Experience with verbal abuse, threats, or humiliating behaviors was associated with more job stress, higher presenteeism, and poor psychological well-being. Study findings suggest that a comprehensive WPV prevention program accompanied by interventions aiming to reduce job stress and improve the well-being of nurses should be actively implemented. To prevent psychological WPV and improve the health of nurses, evidence-based efforts, such as establishment of WPV prevention procedures and education/training of workers at the national, organizational, and individual levels are needed.

Health Care Worker Violent Deaths in the Workplace: A Summary of Cases From the National Violent Death Reporting System.

Violent workplace deaths among health care workers (HCWs) remain understudied in the extant literature despite the potential for serious long-term implications for staff and patient safety. This descriptive study summarized the number and types of HCWs who experienced violent deaths while at work, including the location in which the fatal injury occurred. Cases were identified from the Centers for Disease Control and Prevention's National Violent Death Reporting System between 2003 and 2016. Coded variables included type of HCW injured, type of facility, and location within the facility and perpetrator type among homicides. Frequencies were calculated using Excel. Among 61 HCW deaths, 32 (52%) were suicides and 21 (34%) were homicides; eight (13%) were of undetermined intent. The occupations of victims included physicians (28%), followed by nurses (21%), administration/support operations (21%), security and support services (16%), and therapists and technicians (13%). Most deaths occurred in hospitals (46%) and nonresidential treatment services (20%). Within facility, locations included offices/clinics (20%) and wards/units (18%). Among homicide perpetrators, both Type II (perpetrator was client/patient/family member) and Type IV (personal relationship to perpetrator) were equally common (33%). Suicide was more common than homicide among HCW fatal injuries. Workplace violence prevention programs may want to consider both types of injuries. Although fatal HCW injuries are rare, planning for all types of violent deaths could help minimize consequences for staff, patients, and visitors.

Workplace violence towards resident doctors in Indian teaching hospitals: A quantitative survey.

Violence at work is becoming an alarming phenomenon worldwide affecting the millions of health care workers. This study was conducted to assess the violence towards Resident doctors in Indian teaching hospitals. Google forms questionnaire was developed and circulated electronically to resident doctors working in India. Data were collected and managed using the Google forms electronic tool. Vast majority (86%) of respondents reported having experienced violence with no difference among two genders. Prevalence of violence was maximum (35.5%) in general surgery. Verbal threat and abuse was the commonest (∼94%) form of violence. Mostly these acts of violence happened in Emergency/Trauma room. The most common reasons for violence in hospital were patient's death. Over 94% residents accepted that they had never received any training to deal with work place violence. Majority (80%) of the respondents favoured better communication, strict Laws and strengthening of security measures in hospital to prevent WPV. Workplace violence prevention should be addressed aggressively and comprehensively in health care. A workplace violence prevention program should be a required component of all health care organizations.

Designing a workplace violence prevention and recovery program

Designing a workplace violence prevention and recovery program

The Development and Effectiveness of a Clinical Training Violence Prevention Program for Nursing Students.

The study aimed to develop and evaluate a violence prevention program for nursing students to improve communication self-efficacy, problem-focused coping style, emotion-focused coping style, and the ability to cope with violence. Using an eight-session violence prevention program, the study was designed as quasi experimental, with a pretest, posttest, and follow-up assessment with a nonequivalent control group. Nursing students from the fourth year of a university were selected as participants; 22 students were assigned to the experimental group and 23 to the control group. Data analysis included Chi-square, Fisher’s exact test, Levene’s Test, Mann–Whitney U-test, and repeated measures ANOVA. Results showed that the experimental group showed significantly higher posttest scores for the problem-focused coping style (F = 20.77, p < 0.001), intra-individual and interaction effects for the emotion-focused coping style (F = 12.03, p < 0.001), and the ability to cope with violence (U = 70, p < 0.001) than the control group. Thus, the workplace violence prevention program was effective for nursing students.

NewsCAP: Workplace violence prevention programs in health care facilities.

AJN, American Journal of Nursing: November 2019 - Volume 119 - Issue 11 - p 14 doi: 10.1097/01.NAJ.0000605296.07909.fd

Workplace Violence in Health Care: An Overview and Practical Approach for Prevention

Workplace violence has infiltrated almost every industry in our society, but research has shown that mental health workers are among those most at risk for workplace violence. In addition to the risk of physical harm, this epidemic of workplace violence can lead to negative impacts on overall health and wellness, including poor job satisfaction, anxiety, burn out, and other adverse effects. National organizations such as the Occupational Safety and Health Administration have created guidelines to help address the issue of workplace violence. Along with education and awareness, combating the problem requires comprehensive workplace violence prevention programs and system-level changes from organizations. This article describes a three-pronged approach to minimize workplace violence in the high-risk area of psychiatric emergency care. [ Psychiatr Ann . 2019;49(11):482–486.]

New Jersey Home Health Care Aides Survey Results.

The objective of the study was to report on what violence-based training home health care aides received, their participation in health promotion classes, and home health care aides' experience with workplace violence. In 2013, a mail survey was completed by 513 home health care aides in the state of New Jersey. Ninety-four percent of the respondents were female. Respondents whose agency was part of a hospital were more likely to receive violence-based safety training than respondents whose agency was not part of a hospital (p = .0313). When the perpetrator of violence was a patient or family member, the respondents experienced verbal abuse the most (26%), then physical assault (16%) and exposure to bodily fluids (13%). Home health care aides whose agency was part of a hospital were more likely to receive violence-based safety training. Training is an important component of a workplace violence prevention program.