The present project was aimed at the location of an evidence-based solution to a problem of violence and safety issues faced by nurses working in the emergency department. Furthermore, the project was focused on the identification of an effective evidence-based solution strategy for the problem in question, and the establishment of an efficient intervention based on this strategy. This way, several steps that are described in this paper were taken to determine the problem, review evidence for solutions, create and implement a change plan, and evaluate its outcomes.
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The Problem in Question Described
The environment of an emergency department is generally associated with stress, much action and pressure, critical situations, fast responses, and intense emotions. As a result, these conditions often lead to the occurrence of conflicts between staff members and patients, as well as their families. The emergence of such conflicts negatively impacts the overall state of safety and security that must be maintained in healthcare units and facilities at a high level (Gillespie, Gates, Kowalenko, Bresler, & Succop, 2014). Dangers brought about by violence and conflict situations can be prevented or avoided via the necessary countermeasures helping to establish peaceful and productive communication (Albashtavi, 2017). Specifically, medical personnel can be trained to handle dangerous conflicts situations and preserve safety in the workplace.
The threat of facing violence exists at various stages of work in an emergency department. In particular, it can occur while providing primary care, speaking with patients and their families, or transporting patients to other units. Patients can cause harm to medical staff willingly and unintentionally (Lenaghan, Cirrincione, & Henrish, 2018). The danger is aggravated when emergency department personnel works with people under the influence of substances such as alcohol and drugs, patients who have guns, are agitated due to their trauma, or suffering from delirium (Bayram , Çetin, Oray, & Can, 2017; Stene, Larson, Levy, & Dohlman, 2015). Additionally, medical personnel can be at risk in territories outside their workplaces such as parking lots and areas around hospitals (Tadros & Kiefer, 2017). As a result, it is critical to provide the professionals with all the available skills and knowledge necessary to avoid or prevent conflict situations and preserve their own safety.
The PICOT Question Presented
Do emergency room healthcare providers (p) given safety and violence protocol training (i) compared to those providers not given the safety and violence protocol training (c) demonstrate increased knowledge of safety and violence policies and procedures (o) over the next six weeks (t)?
Search Strategy Created
In order to locate and access literature suitable for this project, it was decided to rely on simple Google Search engine as well as medial databases such as PubMed and CINAHL. Out of a variety of sources located on the resources, the ones that match the requirements of this project were selected. To be included in the review for this project, studies had to explore the issue of violence and safety in medical settings and emergency department in particular. Moreover, the included studies also had to focus on the delivery of education and safety training programs as interventions for the prevention dangers in the workplace related to violence.
Evidence Reviewed and Synthesized
Multiple studies were found that reflected the problem on which this project is focused. The vast majority of studies exploring the problem of safety and violence in the workplace aimed at medical staff are concentrated on the provision of safety training and education to the personnel as the major preventative measure (Brann & Hartley, 2017; Brunetto et al., 2016; Gillespie, Farra, & Gates, 2014; McCaughey, DelliFraine, & Erwin, 2015; Stene et al., 2015). Moreover, the findings of all of the reviewed studies showed that safety training and education that can be delivered using both online and real-life classes prove to be effective strategies. In particular, these techniques help staff members learn more about the ways to prevent conflicts in the workplace that could potentially lead to dangerous situations.
As a result, a conclusion can be made that the implementation of a program based on delivery of an educational curse covering safety training and the prevention of conflicts can be an effective intervention. Namely, the benefits of that this intervention can potentially bring about include the improvement of safety in the workplace, an increased level of awareness of conflict mitigation and appropriate responses to dangerous situations (Brunetto et al, 2016; Gillespie et al., 2014).
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Purpose of the Project Translated into a Change Plan
The purpose of this project was to find an effective evidence-based solution for the problem of violence and safety in the emergency department. The solution that was located by means of the review of suitable research studies involved the delivery of education and safety training to emergency department staff members at risk of facing workplace violence. As a result, a plan was created to deliver a series safety training sessions to the nursing staff of a chosen emergency department. In total, 10 participants were involved in the project that took six weeks. Another two weeks were dedicated to pre- and post-evaluation processes.
Implementation Plan Formulated
For the project implementation, an educational program and safety training sessions were created based on several topics starting with the familiarization of the participants with risks of workplace violence. Also, the program covered strategies helping nurses avoid conflict situations and cope with dangers of various degrees of severity. The sessions included several tests and feedback exchanges that helped to maintain the implementation at the effective level by listening to what the participants were most interested in learning. Also, some of the sessions were tailored specifically as responses to problems and needs expressed by the participants personally. For example, nurses were asked to share their experiences with workplace violence and dangers and inquired about the specific situations they wanted to know how to manage.
Evaluation Plan Created
In was planned to evaluate the outcomes of this project by means of collecting data about the participants’ perception of and experiences with workplace violence before and after the intervention. A survey was created that helped collect data before the nurses enrolled in the educational program. The survey contained both closed- and open-end questions. Further, a post-intervention data collection session involved a similar survey right after the implementation stage was finished and a week after that to assess the experiences nurses had with violence in the workplace and whether or not their responses and attitudes changed due to the intervention.
Outcomes Evaluated and Data Analyzed
The data collected in the form of closed-end questions before and after the intervention was put into practice was analyzed using a Likert scale. Further, comparisons were drawn between the two sets of responses provided by project participants. The findings indicated a significant improvement in the level of confidence of nurses in regard to potential conflict situations and dangers. Another significant change was detected in the level of knowledge had about conflict situations, their causes, development process, and the ways to avoid or prevent them. In open-end questions, nurses were asked to share their perceptions of their levels of preparedness to handle workplace conflicts before and after the intervention was performed. Also, they were asked to comment on the contents of the intervention and note if they found it useful. All nurses reported having learned something valuable for their practice. The vast majority said that they had developed new skills in regard responding to workplace violence.
In addition, it is important to notice that in order to follow-up with the intervention outcomes and findings, the participants were contacted once again a week after their educational sessions and safety training were completed. This was done for the purpose to find out whether or not they had a chance to apply their new skills and knowledge in practice. The purpose of this follow-up was to learn about the practical value of the delivered information and education for nursing practitioners in the emergency department who face workplace violence as an everyday danger. Five out of ten participants reported having been in conflict and dangerous situations over the week. All of them said that using the new knowledge and skills helped them minimize risks in such situations and avoid their aggravation.
Project Results Disseminated
The overall outcomes of this project were evaluated as positive. Accordingly, they were shared with the members of all departments including the professionals working in the emergency department. This was done with the purpose to inform the practitioners of various disciplines that they are at risk of facing workplace violence and that this risk can be mitigated. The professionals were familiarized with the project findings and informed that there are skills and knowledge that are available for the medical staff members interested in learning about conflict management in the workplace.
Albashtavi, M. (2017). Workplace violence against nurses in emergency departments in Jordan. International Nursing Review, 60(4), 550-555.
Bayram, B., Çetin, M., Oray, M., & Can, I. (2017). Workplace violence against physicians in Turkey’s emergency departments: A cross-sectional survey. BMJ Open, 7, 1-10.
Brann, M., & Hartley, D. (2017). Nursing student evaluation of NIOSH workplace violence prevention for nurses online course. Journal of Safety Research, 60, 85-91.
Brunetto, Y., Xerri, M., Farr‐Wharton, B., Shacklock, K., Farr‐Wharton, R., & Trinchero, E. (2016). Nurse safety outcomes: Old problem, new solution – The differentiating roles of nurses’ psychological capital and managerial support. Journal of Advanced Nursing, 72(11), 2794-2805.
Gillespie, G. L., Farra, S. L., & Gates, D. M. (2014). A workplace violence educational program: A repeated measures study. Nurse Education in Practice, 14(5), 468-472.
Gillespie, G. L., Gates, D. M., Kowalenko, T., Bresler, S., & Succop, P. (2014). Implementation of a comprehensive intervention to reduce physical assaults and threats in the emergency department. Journal of Emergency Nursing, 40(6), 586-591.
Lenaghan, P. A., Cirrincione, N. M., & Henrish, S. (2018). Preventing emergency department violence through design. Journal of Emergency Nursing, 44(1), 7-12.
McCaughey, D., DelliFraine, J., & Erwin, C. O. (2015). Best practices to promote occupational safety and satisfaction: A comparison of three North American hospitals. Advances in Health Care Management, 17, 137-159.
Stene, J., Larson, E., Levy, M., & Dohlman, M. (2015). Workplace violence in the emergency department: Giving staff the tools and support to report. The Permanente Journal, 19(2), e113-e117.
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Tadros, A., & Kiefer, C. (2017). Violence in the emergency department. Psychiatric Clinics, 40(3), 575–584.
Evidence Synthesis Table.
|Study #1||Study #2||Study #3||Study #4||Study #5||Synthesis|
|(p) Population||Nursing students from mid-Atlantic University (both bachelors and masters)||Professional nurses working in 6 hospitals in Australia||Healthcare specialists working in emergency departments||Healthcare employees in the United States and Canada||Nursing specialists from emergency departments in the United States||Available evidence relates to students, nurses, and other healthcare specialists in three English-speaking countries|
|(i) Intervention||NIOSH online course for nurses (violence prevention)||Training aimed at the development of psychological capital and other safety interventions||Hybrid workplace violence educational program designed for healthcare specialists in emergency departments||Occupational safety training||Incident reporting tool and the educational program||The interventions are presented by courses and programs that include both online and offline education|
|(c) Comparison||The results of knowledge tests taken before and after the intervention were compared||The absence of training||Before and after the intervention||The absence of training program and safety leadership||Before and after the education||The majority of studies focus on changes over time|
|(o) Outcome||The participants demonstrate increased awareness and knowledge||Improved nurse safety outcomes||Improved learning outcomes||Reduced injury rates and improved safety outcomes||An increased number of violent acts and conflicts that are reported, an increased workplace safety (perceived by the participants)||Interventions are aimed at achieving both theoretical (knowledge) and practical (performance) results|
|(t) time||One month||–||Six months||–||Twelve months||There is a lack of longitudinal studies related to the topic|
|Citation||Design||Sample size:||Major||Study||Level of||Evidence|
|1. Brann, M., & Hartley, D. (2017). Nursing student evaluation of NIOSH workplace violence prevention for nurses online course. Journal of Safety Research, 60, 85-91.||The mixed-methods study design has been chosen (the evidence was retrieved with the help of surveys and focus group discussions)||The sample size can be regarded as rather small (48 students completed the final survey and 40 of them took part in discussions)||Dependent variable in the study is the completion of the chosen online course for nurses; |
independent variables include the level of workplace violence awareness and changes related to the knowledge level of participants
|Strengths: the study involves numerous practical applications, uses both quantitative and qualitative data, and promotes violence education; limitations: sample size, the inability to evaluate the impact of additional sources of information (peer-to-peer communication, other courses)||Level IV||The study demonstrates that the online course under consideration has a positive impact on violence awareness and knowledge in future specialists, proving its effectiveness. Despite that, the sample size acts as a factor that makes it impossible to generalize the results, and it is hard to predict the extent to which the course would be helpful for students from other locations|
|2. Brunetto, Y., Xerri, M., Farr‐Wharton, B., Shacklock, K., Farr‐Wharton, R., & Trinchero, E. (2016). Nurse safety outcomes: Old problem, new solution – The differentiating roles of nurses’ psychological capital and managerial support. Journal of Advanced Nursing, 72(11), 2794-2805.||Quantitative study based on the survey results||The sample includes 242 nursing professionals, and it is possible to state that it is adequate to the research needs||Independent variables: managerial safety priorities, safety training, psychological capital, age, education level; dependent variable – in-role safety performance||Strengths: adequate sample size, the study focuses on underresearched area and expands the knowledge concerning the importance of psychological capital in nursing practice; limitations – possible bias caused by the use of self-reports||Level III||The study proves that the level of psychological capital, safety training, and managerial support have an impact on the safety performance of nurses. The evidence presented by the researchers can be used to design effective strategies aimed at improving the safety performance of professional nurses|
|3. Gillespie, G. L., Farra, S. L., & Gates, D. M. (2014). A workplace violence educational program: A repeated measures study. Nurse Education in Practice, 14(5), 468-472.||A quasi-experimental quantitative study based on survey results||The sample includes 120 participants, and it may need to be improved to get more credible results||Dependent variable: the time of testing (the participants were required to complete three tests, one before and two after the proposed education; independent variable: the results of tests indicating the knowledge of workplace violence||Strengths: the choice of method allows providing specific findings that are easily generalized, the study expands the knowledge on effective nurse education strategies; |
limitations: the inability to take other potential influences into account (self-tuition, communication, etc.)
|Level III||The research proves that hybrid violence prevention education programs improve knowledge retention over time and, therefore, improve the effectiveness of education for professionals. The research indicates the effectiveness of proposed educational programs that include online training and group discussions, and the evidence can be used to strengthen the proposed research and develop a more effective safety and violence protocol training|
|4. McCaughey, D., DelliFraine, J., & Erwin, C. O. (2015). Best practices to promote occupational safety and satisfaction: A comparison of three North American hospitals. Advances in Health Care Management, 17, 137-159.||The article presents the results of a quantitative non-experimental research based on survey results||The sample includes employees from three emergency aid hospitals (one in the United States and two in Canada), the total number of participants is 352||Independent variables: safety training, safety leadership; dependent variables: personal safety perceptions of employees in acute care hospitals and the safety grades of units||Strengths: employees from both countries work for the same organization, and the exposure to identical training practices allows providing reliable results; also, the sample size acts as a strength; limitations: the results cannot be compared with regard to international context; the impact of personal bias||Level IV||The study indicates that the work environment is closely interconnected with safety outcomes and highlights the connection between safety training and the safety scores of healthcare units. Even though there are limitations acknowledged by the researchers, the results can be used by healthcare managers to improve current practices related to workplace safety training and reduce the cases of work-related injuries|
|5. Stene, J., Larson, E., Levy, M., & Dohlman, M. (2015). Workplace violence in the emergency department: Giving staff the tools and support to report. The Permanente Journal, 19(2), e113-e117.||The article presents the results of a quantitative research based on survey results||The sample that has been chosen for the research includes 120 nurses from different emergency departments in the United States. In terms of the adequacy of sample size, the researchers may need to increase the number of participants to provide more credible results that would be relevant to all nurses in emergency departments||Dependent variables: the degree of perceived workplace safety, the rate of reported incidents related to workplace violence; independent variables; the time of surveying (the researchers have conducted three surveys: one before and two after the education)||Strengths: the use of reporting tools has a positive impact on workplace violence awareness among specialists in emergency departments; the study expands the knowledge concerning factors that can decrease the number of reported work-related incidents; the results of the study can also be used in order to create a more positive working environment; limitations: the sample size is not large enough to prove that the results can be applied to all healthcare specialists in emergency departments; also, there is a possible threat to data accuracy as a few new employees also completed the second survey; finally, the researchers did not have an opportunity to recruit participants from different locations||Level IV||The research under consideration indicates that special educational programs for healthcare specialists in emergency departments can be successfully used to improve the knowledge of the latter on cases that involve workplace violence, the importance of timely reporting, and the right way to use violence reporting tools. The limitations of the study such as the sample size and the choice of one location present the reason why further research may be necessary; nevertheless, the results can be used to improve work environment and perceived workplace safety in emergency departments|