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TechniquestoReduceViolenceAgainstRegisteredNursesintheEmergencyDepartment

MichaelA.ZielinskiII,DNP,APN,CEN,RN,EMT

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DisclosureofConflictofInterest

•  Theauthorofthispresentationhasnoconflictofinteresttodisclose.

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•  Dr.MichaelA.ZielinskiIIhasbeenaRegisteredNurseforover26years,aNursePractitionerforover9years,wasAdjunctfacultyforthreeColleges/UniversitiesandisexperiencedinTrauma,theEmergencyDepartment,CriticalCareTransport,PainManagement,UrgentCare,andOccupationalMedicine.

•  Dr.ZielinskiisalsoaPoliceOfficerforover28yearsandhasbeenassignedtomultiplespecialtyunits&divisions;includingthePatrolDivision,TrafficUnit,EMSUnit,BicycleUnit,PoliceAcademy,andtheCriminalInvestigationsBureau.

•  Dr.Zielinski'sinterestinviolenceanditsprecipitatingfactorsinthehealthcareworkplacestemsfromhisvariedbackgroundandexperienceinNursing,LawEnforcementandtheEmergencyMedicalService(EMS).

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Objectives

•  Bytheendofthispresentationtheparticipantwillbeabletodescribethetechniquestorecognizethevarioustypes,signs,andactionsofviolence.

•  Bytheendofthispresentationtheparticipantwillbeabletodescribetechniquestode-escalateviolentbehavior.

•  Bytheendofthispresentationtheparticipantwillbeabletodescribethetechniquestomitigateviolentbehavior.

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ViolenceintheNews

•  ApsychiatricpatientopenedfireinsideaHealth&WellnessCenterinDarby,PA.Accordingtopolicehiscaseworkerwaskilledandadoctorsufferedagrazewoundtothehead.Intheexchange,policetellNBC10thedoctorreturnedfirewithhisowngun,criticallywoundingthesuspect.(Philadelphia)

•  Patientattacksnursingstaffwithametalbedrail.Beatingfournursesintheheadwiththemetalbedrail.(Minnesota)

https://www.youtube.com/watch?v=ZTMKMWjx7zk

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Provisions

•  (1)Thenursepracticeswithcompassionandrespectfortheinherentdignity,worth,anduniqueattributesofeveryperson.

•  (2)Thenurse’sprimarycommitmentistothepatient,whetheranindividual,family,group,community,orpopulation.

•  (3)Thenursepromotes,advocatesfor,andprotectstherights,health,andsafetyofthepatient.

•  (4)Thenursehasauthority,accountability,andresponsibilityfornursingpractice;makesdecisions;andtakesactionconsistentwiththeobligationtopromotehealthandtoprovideoptimalcare.

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•  *(5)Thenurseowesthesamedutiestoselfastoothers,includingtheresponsibilitytopromotehealthandsafety,preservewholenessofcharacterandintegrity,maintaincompetence,andcontinuepersonalandprofessionalgrowth.

•  (6)Thenurse,throughindividualandcollectiveeffort,establishes,maintains,andimprovestheethicalenvironmentoftheworksettingandconditionsofemploymentthatareconducivetosafe,qualityhealthcare.

•  (7)Thenurse,inallrolesandsettings,advancestheprofessionthroughresearchandscholarlyinquiry,professionalstandardsdevelopment,andthegenerationofbothnursingandhealthpolicy.

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•  (8)Thenursecollaborateswithotherhealthprofessionalsandthepublictoprotecthumanrights,promotehealthdiplomacy,andreducehealthdisparities.

•  (9)Theprofessionofnursing,collectivelythroughitsprofessionalorganizations,mustarticulatenursingvalues,maintainintegrityoftheprofession,andintegrateprinciplesofsocialjusticeintonursingandhealthpolicy.

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•  Maybethesewillhelp…

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DefinitionofViolence! Historically,violencewasdefinedasaspectrumofbehaviorsrangingfrompassiveaggressiontohomicide(Perrone,1999).

! Violenceisdefinedas“theuseofphysicalforcetoharmsomeoneortodamageproperty,theexertionofphysicalforcesoastoinjureorabuse,anintenseturbulent,orfuriousandoftendestructiveactionorforceandinjuryasifbydistortion,infringement,profanationorfowllanguage”(Merriam-Webster,2014).

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TypesofViolence

! Physical-hit,slapped,kicked,bitten,sexuallyassaulted,subjectedtophysicalcontactintendedtoharm(Pinar&Ucmak,2010).

! Verbal-anyuseoflanguagethataimsatintimidating,frighteningorharmingoryellingorswearingorotherwordsintendedtocontrolorhurt(Pinar&Ucmak,2010),97-100%oftheEDstaffwillexperiencesomeformofverbalabuse.

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SignsandActionsofViolence

! Aggravation! Anger! Disgust! Cursing! Combativeness! Facialexpressions! Toneofvoice

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TechniquesforDe-EscalatingViolentBehavior

! Step1-AssesstheSituation

! Step2-RemainCalm(Focus,Honesty,Communication)

! Step3-Acknowledgeconcerns

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EveryDayPractice

! Knowwhatviolenceis! Recognizeviolentbehaviors! Useskillstode-escalatetheviolentbehaviors! Useknowledgeandskilltomitigate(lessen)theseverityoftheviolentbehaviors

! Continuetoreapplythestepsofrecognition,de-escalation,andmitigationoftheviolentbehaviors

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Education

•  EducatingthepublicontheoperationoftheEmergencyDepartment(Anderson,FitzGerald,&Luck,2010)

•  EducatetheRegisteredNurseonhowtorecognize,de-escalateandmitigateviolentbehavior

•  EducatetheRegisteredNurseusingrealisticsituationsthatareactuallyexperiencedintheEmergencyDepartment

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Statistics

•  50%oftheworkersintheEmergencyDepartmentwillbephysicallyassaulted

•  46%ofallnonfatalinjuriesfromworkplaceviolenceoccursinhealthcareorsocialservicesettingsintheU.S.

•  65%ofincidencegounreported

•  97-100%ofEmergencyDepartmentworkerswillexperiencesomeformofverbalabuse

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TechniquestoReduceViolenceInclude

Educationon…! Recognition! De-escalation! Mitigation

Followedby…! Commitmenttoreduceviolence! Reportingactsofphysicalorverbalviolence! ZeroTolerance

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NewJerseyLaw

•  UnderNJlawifanactofsimpleassault(i.e.apush,smack,pinch,spatupon,etc.)iscommitteduponanurseorotherhealthcareproviderduringtheperformanceoftheirduties,theactisautomaticallyelevatedtoanaggravatedassaultwithenhancedpenalties,increasedfinesandpossibleincarceration(NJSA:2C:12-1b(1)(5)(C)).

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Penalties

•  ThirdDegreeCrime(BodilyInjury)Fines:(nottoexceed)$15,000+CourtCost& MandatoryAssessmentsJail:3-5years(Mitigating)&5-10years(Aggravating)•  FourthDegreeCrimeFines:(nottoexceed)$10,000+CourtCost&

MandatoryAssessmentsJail:3-5years•  MandatorySentencingGuidelineswillapplyifa“deadlyweapon”wasusedduringthecommissionofthecrime&alsoifthedefendantisaRepeatOffender.

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•  Maybethesewillhelp…

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SomethingtoThinkAbout#1

•  ConveyorBeltMedicine-SymptomsoraDiagnosiscanleadtotheinitiationofanautomatictreatmentplan.

•  Howcanthisprocessaffectpatients,theirfamiliesandfriends?

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SomethingtoThinkAbout#2

•  NewJersey(06/11/2019)-Enactedalawthatrequireshotelstoprovide“PanicButton”devicesto“HouseKeepingStaff”toensuretheirsafetywhileonduty.

•  Whatabout“HealthCareStaff”?

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Conclusion

•  ViolencehasestablisheditselfasaneverydayoccurrenceagainstEDregisterednurses.Anon-goingandrealisticeducationprogramonhowtorecognize,de-escalateandmitigateviolentbehaviorshasbeenaneffectivemethodtoreduceviolenceagainstnurses.Itisimportanttohavecontinuedsupportofhealthcareadministration,legislationandpoliciestoeradicateviolencefromthehealthcareworkplace.ThiswillallowEDregisterednursestoprovideexcellentcaretotheirpatientswhileenjoyingasafeworkenvironment.

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Summary

•  Violenceisaglobalissue(Sterlingetal.,2001)•  Reduceviolencethrougheducation•  RegisteredNurseswhoworkintheEmergencyDepartmentarefrequentlyatincreasedriskofviolenceduetothenumberofpatientsandvisitorsbeingseen.

•  Thesuccessofthede-escalationprocessdependsuponthenurse’scommitmenttoresolveanyissuesandmaintainacalmandsafeenvironment(Cowinetal.,2003).

•  ZeroTolerance-Violenceisnotpartofthejob

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Questions?

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References

! AmericanNursesAssociation(ANA).(2016).CodeofEthicsforNurses.SilverSpring,MD:Author.Retrievedfromhttp://www.nursingworld.org/codeofethics

! Anderson,L.,FitzGerald,M.,&Luck,L.(2010).Anintegrativereviewofinterventionstoreduceviolenceagainstemergencydepartmentnurses.JournalofClinicalNursing,19,2520-2530.

! Barchenger,S.(2019).NewJerseyisfirstinthenationtorequirepanicbuttonsforhotelworkers.USAToday.Retrievedon06/12/2019fromhttps://www.msn.com/en-us/travel/news/new-jersey-is-first-in-the-nation-to-require-panic-buttons-for-hotel-workers/ar-AACMt3H?ocid=spartandhp

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! Black,R.(2017).ShouldHealthcareEmployeesWearBodyCameras?Retrievedon06/04/2019fromhttps://www.idigitalhealth.com/news/should-healthcare-employees-wear-body-cameras

! Cowin,L.,Davies,R.,Estall,G.,Berlin,T.,Fitzgerald,M.&Hoot,S.(2003).De-escalatingaggressionandviolenceinthementalhealthsetting.InternationalJournalofMentalHealthNursing,12,64-73.

! Ferns,T.(2005).Violenceintheaccidentandemergency-aninternationalperspective.AccidentandEmergencyNursing,13(3),180-185.

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! Gates,D.M.,Ross,C.S.,&McQueen,L.(2006).Violenceagainstemergencydepartmentworkers.TheJournalofEmergencyMedicine,3(3),331-337.

! May,D.D.&Grubbs,L.M.(2002).Theextent,nature,andprecipitatingfactorsofnurseassaultamongthreegroupsofregisterednursesinaregionalmedicalcenter.JournalofEmergencyNursing,28,11-17.

! Mallidi,J.(2019).ConveyorBeltMedicine:WhereAreTheBrakes?Retrieved06/04/2019fromhttps://www.medscape.com/viewarticle/913493

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! Perrone,S.(1999).Violenceintheworkplace-Australianinstituteofcriminology.InAnderson,L.,FitzGerald,M.,&Luck,L.(2010).AnintegrativereviewofinterventionstoreduceviolenceagainstEDnurses.JournalofClinicalNursing,19,2520-2530.

! Pich,J.,Hazelton,M.,Sundin,D.,&Kable,A.(2010).Patient-relatedviolenceagainstEDnurses.NursingandHealthSciences,12,268-274.

! Pinar,R.&Ucmak,F.(2010).Verbalandphysicalviolenceinemergencydepartments:AsurveyofnursesinTurkey.JournalofClinicalNursing,20,510-517.

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! Stirling,G.,Higgins,J.E.&Cooke,M.W.(2001).Violenceinaccident&emergencydepartments:Asystematicreviewoftheliterature.AccidentandEmergencyNursing9,77-85.

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