WORKPLACE AGGRESSION & VIOLENCE PREVENTION TRAINING PROGRAMAngela R. Story, MSN, RN, NEA-BC, DNP Student

MU Sinclair School of Nursing

Background & Significance• 74% of nonfatal injuries, violent events, and occupational assaults

occurred within health care and social services.10

• Workplace violence is highly prevalent, yet often underreported for

health care workers, especially nurses.3

• Workplace aggression/violence consists of assaults, threatening,

harassing, coercive behavior, & emotional/verbal abuse.8

• Patients & visitors, perpetrate most of the violence inflicted on health

care workers.

INTRODUCTION

Mean Responses to CCPA Instrument by question

(Thackrey, 1987)

Results: The nurses’ perception and confidence of aggression and violent events post- and 3-

month post-training showed statistically significant improvement compared to pre-training. Total

M from pre- to post-: 23.5 (42.6%), p=.0000; & pre- to 3-mon post-: 20.7 (37.6%), p=.0000.

Therefore, results suggest learning from training was sustained from pre- to 3-months post-.

Objective 1 Met: Improved perception, “How comfortable are you in working with an

aggressive patient?” pre- M = 6.73 & post- M = 8.32, p = .0066 showed a 23.6% increase from

the pre- to post- level.

Objective 2 Met: Improved confidence, “How self-assured do you feel in the presence of an

aggressive patient?” pre- M = 6.37 & post- M = 7.91, p = .0726 showed a 24.4% increase

METHODS

1. Anderson, C. (2006). Training efforts to reduce reports of workplace violence in a community health care facility. Journal of

Professional Nursing. 22(5), 289-295.

2. 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.

3. Arnetz, J.E., Hamblin, L., Essenmacher, L., Upfal, M. J., Ager, J., & Luborsky, M. (2014). Understanding patient-to-worker

violence in hospitals: A qualitative analysis of documented incident reports. Journal of Advanced Nursing. 71(2), 338-348.

4. Deans, C. (2004). The effectiveness of a training program for emergency department nurses in managing violent situations.

Australian Journal of Advance Nursing. 21(4), 17-22.

5. Gerdtz, M. F., Daniel, C., Dearie, V., Prematunga, R., Bamert, M., & Duxbury, J. (2013). The outcome of a rapid training program

on nurses’ attitudes regarding the prevention of aggression in emergency departments: A multi-site evaluation. International

Journal of Nursing Studies. 50(11), 1434-1445.

6. Kynoch, K., Wu, C. J., & Chang, A. M. (2011). Interventions for preventing and managing aggressive patients admitted to an

acute hospital setting: A systematic review. Worldviews Evidence Based Nursing. 8(2), 76-86.

7. Mohr, D., Warren, N., Hodgson, M. J., & Drummond, D. J. (2011). Assault rates and implementation of a workplace violence

prevention program in the Veterans Care Administration. Journal of Occupational and Environmental Medicine. 53(5), 511-516.

8. Taylor, J. L., & Rew, L. (2010). A systematic review of the literature: Workplace violence in the emergency department. Journal

of Clinical Nursing. 20(7-8), 1072-1085.

9. Thackrey, M. (1987). Clinician confidence in coping with patient aggression: Assessment and enhancement. Professional

Psychology: Research and Practice, 18(1), 57-60.

10. U.S. Department of Labor, Occupational Safety and Health Administration. (2015). Guidelines for Preventing Workplace

Violence for Healthcare and Social Service Workers. (OSHA Publication No. 3148-04R 2015). Retrieved from

https://www.osha.gov/about.html

11. Wassell, J. T. (2009). Workplace violence intervention effectiveness: A systematic literature Review. Safety Science. 47(8), 1049-1055.

The project director would like to offer many thanks to Dr. Amy Vogelsmeier (Committee Chair), Dr. Robin

Harris (Committee Member), Dr. Susan Scott (Committee Member), Dr. Jan Sherman, Dr. Richard Madsen,

Dr. Mary Beck, Dr. Michael Thackrey, and the MU Health Care experts and leaders: Mr. Jonathan Curtright,

Mr. Robert Schaal, Mr. John Hornick, Ms. Marla Smith, Ms. Melissa Jost, Mr. Steve Firmand, Mrs. Stephanie

Hunt, and Mrs. Ceresa Ward.

Angela Story: storya@health.missouri.edu

MU Sinclair SON: http://nursing.missouri.edu/index.php

QI objectives were met with statistically significant improvement,

which is consistent with other WVP training studies.

Findings suggest WVP training has benefits and can make a

difference in confidence in coping with aggressive patients.

These benefits are encouraging and support the continuation of

training after enhancement of training and materials.

CONCLUSIONS

RESULTS

PURPOSE: Quality improvement project to evaluate how WVP training affects

nurses’ perception of aggression/violent events in adult inpatient hospital setting

PICOT/PURPOSE STATEMENT

WVP training benefits for participant’s

• Workplace violence risk awareness, and ability to manage

aggression,2 and understanding for aggression causes.5

• Improvement in workplace violence knowledge, confidence, & skills1-6

• Staff felt more supported by administration; lessening some staff

anxiety, with decreased patient anxiety; thus, decreased events.4

• Decreased events benefits were demonstrated by improved

skills, knowledge, and confidence.1-5

• Decreased by 5% events & 40% worker’s compensation.7

• Due to a lack of standardization in training, definition,

instruments, & setting the findings were inconclusive and more

studies were needed.11

REVIEW OF LITERATURE

OBJECTIVES

At least a 5% total mean (M) increase in participant responses from

pre- to post- question: Will a WVP training program be effective to:

(1) improve nurse’s perception to manage workplace aggression

and violence

(2) increase nurses’ confidence in dealing with workplace

aggression and violence?

REFERENCES

ACKNOWLEDGEMENTS

Mean Responses to CCPA Instrument at Pre, Post, & 3

month post-training (Thackrey, 1987)

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PRE-TRAINING POST-TRAINING 3-MONTH TRAINING

CONFIDENCE IN COPING TRAINING

TOTAL MEAN SCORE

Total Mean Responses to CCPA Instrument at Pre,

Post, & 3 month post-training (Thackrey, 1987)

METHODS

STUDY DESIGN

• Descriptive longitudinal design to evaluate the effect of a WVP

training on nurses’ perception of aggression and violent events

• Institutional Review Board approved as quality improvement project

SETTING

• Collaborated with MU Health Care - Academic Health Care (AHC)

Population Sample

Recruitment

• Registered Nurses (RN) working in AHC and participants of WVP training

• Recruited by MUHC Nurse Managers

• Convenience sample of all eligible (n = 930) & willing AHC nurses resulted in sample size of 43 participants. Twenty-two participants completed all survey stages (pre-, post-, & 3-mon post-)

WVP Training

• WVP training two-hour sessions

• Training components included WVP types, policy, risks, aggression/violence recognition with prevention strategies, behavior management techniques, response plan, & event reporting/tracking

• Training design based on ANA, CDC, ENA, FEMA, NIOSH, OSHA, TJC, and WHO recommendations

Evaluation

• Pre-, post-, & 3-month post-training measurement

• Thackrey’s (1987) Confidence in Coping with Patient Aggression (CCPA) instrument

• 10 question 11-point Likert-scale survey

PICOTIn nurses working in an adult inpatient hospital setting

at risk for aggression and workplace violence (P)

compared to current training (C)

affect nurse’s perception of aggression and workplace

violence events (O)

how does an aggression prevention and

management program (I)

over 3 months (T)?

S –

Staring & eye

contact

T –

Tone & volume of voice

A –

Anxiety

M –

Mumbling

P –

Pacing

5 Observable behaviors that may indicate

violence: