Literature Evaluation Table
Summary of Clinical Issue (200-250 words): Workplace violence is a growing epidemic among healthcare professionals. Nurses are verbally and physically assaulted across the globe daily while attempting to provide care for the sick and injured. While most incidents of violence towards nurses is merely verbal in nature and does not cause physical harm, the psychological effects toward work satisfaction and safety are present. Even though the majority of violence is verbal in nature, physical violence is a growing problem. The National Crive Victimization Survey showed healthcare workers were 20% more likely to be a victim of workplace violence. The Joint Commission’s Sentinel Event data reports 68 incidents of homicide, rape, or assault of hospital staff members over an 8-year period. The numbers are believed to be much higher since reporting such events is voluntary. These numbers reflect physical assault. The number verbal incidents is much higher but acquiring accurate data reflecting the number of occurrences may be impossible.
The increased risk of verbal and physical assaults toward healthcare providers is alarming. Healthcare professionals are trained to help the sick and injured and are now having to obtain training to prevent the sick and injured from injuring them. There are now formal classes many healthcare institutions require for employees to take to help them identify risk of violence and how to de-escalate and remove themselves from a potentially harmful situation. Do classes who teach such tactics benefit the healthcare professional?
PICOT Question: Does having managed assaultive behavior training among nurses decrease the rate of physical assaults toward staff than those who do not have formal managing assaultive behavior training.
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Adams, J. (2017). Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence. Australian Journal of Advanced Nursing, 34(3), 6–15. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=121890764&site=eds-live&scope=site
Tenley, C., Bergmar, N. M., & Moore, M. (2019). Facing Workplace Violence and Best Practices for Prevention. Employee Relations Law Journal, 45(3), 62–66. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=s3h&AN=139579183&site=eds-live&scope=site |
Heckemann, B., Breimaier, H. E., Halfens, R. J. G., Schols, J. M. G. A., & Hahn, S. (2016). The participant’s perspective: learning from an aggression management training course for nurses. Insights from a qualitative interview study. Scandinavian Journal of Caring Sciences, 30(3), 574–585. https://doi-org.lopes.idm.oclc.org/10.1111/scs.12281
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Kling, R. N., Yassi, A., Smailes, E., Lovato, C. Y., & Koehoorn, M. (2011). Evaluation of a violence risk assessment system (the Alert System) for reducing violence in an acute hospital: A before and after study. International Journal of Nursing Studies, 48(5), 534–539. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2010.10.006
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| How Does the Article Relate to the PICOT Question? | The study assesses the effectiveness of clinical education to help identify patients who are high risk for violence and reduce the frequency of violent incidents. | The study addresses the perspective of the healthcare provider after attending an aggression management training course. | The study compares the rates of assaults to staff before and after the implementation of an alert system. |
| Quantitative, Qualitative (How do you know?) | Quantitative: Data was collected from a staff questionnaire and compared to violent and aggressive incidents in the hospital’s records. | Qualitative: The data was collected from an interview study. | Quantitative: The data is collected from the number of reported violent incidents before, during, and post implementation of an alert system. |
| Purpose Statement | The purpose is to assess the effectiveness of clinical education to provide staff the ability to identify patients who high risk of violence. | Explore and describe, from a nurse’s perspective, the learning gained from attending aggression management training. | To investigate the effectiveness of a risk assessment system in reducing the risk of violence in an acute care hospital in the Canadian province of British Columbia. |
| Research Question | This study assessed the effectiveness of clinical education to identify patients with a high risk for violence and to reduce the frequency of violent incidents. | 1 How does AM training affect nurses’ attitude towards and coping with PVA?
2 How does AM training influence nurses’ PVA prevention, early intervention and de-escalation strategies? |
Does the implementation of an alert system reduce the number of violent incidents in an acute care hospital? |
| Outcome | Education and coaching provided by clinical experts resulted in increased knowledge, greater use of verbal de‑ escalation and less incidents. However, more time/coaching is required to improve the perceived capability of clinical staff to manage these incidents | Nurses reported increased situational and environmental awareness as well as increased confidence and improved technical skills for preventing and managing aggression. | The Alert System even though offered in conjunction with violence prevention training, does not appear to provide the resources or procedures needed by healthcare workers to prevent a patient from progressing to a violent incident once flagged |
| Setting
(Where did the study take place?) |
Data were gathered from the direct care staff and from records of violent/aggressive incidents which occurred on two adult medical wards at a teaching hospital in Western Australia. | The setting of the study is not specifically stated however the interviews were conducted prior to aggression management training among nurses via face-to-face, videotelephony, and telephone. | Acute care hospital British Columbia, Canada |
| Sample | Nurses, Assistants in Nursing and Patient Care Assistants working on the study wards participated in the education intervention (n=65). | 28 Registered Nurses attending an aggression management training. | Hospital violence incident rates (number of incidents/100,000 work hours) |
| Method | 1) staff completed a self‑administered questionnaire and
2) data related to violent/aggressive incidents were obtained from hospital records. |
We conducted semi-structured qualitative interviews before and after an AM training for registered nurses working in Swiss hospitals. | Poisson regression models were used to examine the effect of the Alert System on hospital-level violent incident rates. Multivariable, conditional logistic regression was used to examine the effect of the Alert System on the individual-level risk of violent incidence using a case–control study. |
| Key Findings of the Study |
After education, nurse knowledge and the use of verbal de-escalation increased. The frequency of recurrence in incidents decreased.
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Interestingly, the nurses did not necessarily acquire new PVA management strategies. Instead, the training refreshed existing knowledge, or nurses recognized that they had previously been using de-escalation strategies intuitively.
Nurses reported increased situational and environmental awareness as well as increased confidence and improved technical skills for preventing and managing aggression. |
Although useful at identifying violent patients, the Alert System even though offered in conjunction with violence prevention training, does not appear to provide the resources or procedures needed by healthcare workers to prevent a patient from progressing to a violent incident once flagged. |
| Recommendations of the Researcher | It is essential to embrace pro‑active strategies and have a planned response rather than reacting to incidents. This will ensure staff are better prepared to manage patients with a high risk for violence.
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Aggression management training is an important element of an overall strategy to tackle PVA | Violence in healthcare should be studied and prevented using a multifaceted approach. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Marshall, B., Craig, A., & Meyer, A. (2017). Registered Nurses’ Attitudes Towards, and Experiences Of, Aggression and Violence in the Acute Hospital Setting. Kai Tiaki Nursing Research, 8(1), 31. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edo&AN=127439069&site=eds-live&scope=site
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Elliott, P. P. (1997). Violence in Health Care. Nursing Management, 28(12), 38–41. https://doi-org.lopes.idm.oclc.org/10.1097/00006247-199712000-00012
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Henson, B. (2010). Preventing Interpersonal Violence in Emergency Departments: Practical Applications of Criminology Theory. Violence & Victims, 25(4), 553. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edo&AN=54477816&site=eds-live&scope=site
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| How Does the Article Relate to the PICOT Question? | The article examines the impact of aggression and violence toward nurses in acute hospital setting and how aggression management training impacts their experiences. | The article provides important data about the prevalence of violence in healthcare. | The article provides insight in how to develop crime and violence prevention strategies. |
| Quantitative, Qualitative (How do you know?) | Qualitative: The data was collected by surveying Registered Nurses currently employed in an acute care hospital. | Quantitative: The article provides statistical data collected from various studies and OSHA about the rates of violence in healthcare. | Quantitative: The data collected provides statistical analysis of the prevalence of workplace violence. |
| Purpose Statement | Workplace violence is acknowledged as a significant occupational hazard for all health-care workers. Globally, incidents of violence against health-care workers are increasing in frequency and severity | Health care workers have significantly higher rates of nonfatal on-the-job assaults than those who work in the private sector. | Over the past two decades, rates of violence in the workplace have grown significantly. Such growth has been more prevalent in some fields than others, however. Research shows that rates of violence against healthcare workers are continuously among the highest of any career field. |
| Research Question | How does aggression management training effect a nurses attitude toward aggression and violence? | How prevalent is violence in healthcare? | How does the application of criminology theory decrease violence in the emergency department? |
| Outcome | Participation in AMT was found to have a negligible effect on exposure to aggression or violence and a limited impact on RNs’ attitudes towards aggression and violence. | The incident rate for nonfatal assault in private industry is three cases per 10,00 workers as compared to 38 cases per iO,000 workers in nursing and personal care facilities and 47 cases per 10,000 workers in residential care | The application and examination of the strategies criminological theory should further the ability of hospitals to reduce the rate of violence in EDs |
| Setting
(Where did the study take place?) |
No specific setting was given; however the data was collected from registered nurses in New Zealand via an internet survey. | No specific setting was given. Data was collected from various sources including OSHA. | No specific setting was provide. |
| Sample | 85 Registered Nurses working in a acute care hospital. | No sample provided. | No specific sample was provided however the article sites several studies which researched ED Staff. |
| Method | An internet survey of 85 Registered Nurses who have attended aggression management training. | Data collected from OSHA. | |
| Key Findings of the Study | These results suggest the health-care institutions employing the RNs who participated in this survey may not be meeting their obligations under the Health and Safety at Work Act 2015. | Healthcare providers are at 16 times greater risk for violence than those in other professions. | As a result, there is little understanding of which techniques work and which do not. It is only with an appropriate test of proposed crime prevention techniques that any true progress can be made. |
| Recommendations of the Researcher | High quality, relevant and service-specific AMT programs should be made a mandatory requirement of employment for all RNs and managers working in the health-care system. AMT should be commenced at induction to employment and refreshed regularly. | Violence in the health care environment is intense and far reaching. Interventions must be redesigned; approaches should be proactive, comprehensive and ongoing. To evaluate outcomes, redefine the problem, acquire a new knowledge and develop new skills | Future work in this area should continue to bridge the gap between criminological and medical research. The next most logical step in the process would be test the effectiveness of a crime prevention strategy in a healthcare setting. |
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