title: An Intervention to Improve Nurses’ Knowledge, Perceived Safety, and Confidence in Identifying and Managing Workplace Violence: A Translation of Evidence into Practice
Creators: name: Sullivan, Kayla
Publisher: name: University of Nevada, Las Vegas
Year: 2021

description: The Occupational Safety and Health Administration (OSHA) reports that over two million workers are victims of workplace violence (WPV) (Papa, 2013). Registered nurses are subjected to high risk for workplace violence from patients and visitors, with 25.5% reporting at least one victimization incident (Gillespie et al., 2013). Research indicates that WPV has a significant impact on nurses' quality of working life, job satisfaction levels, turnover rates and has also been shown to negatively impact efficiency and productivity (Gacki-Smith et al., 2009). ED nurses are at substantial occupational risk for workplace violence. Emergency departments have been identified as areas within the hospital in which the incidence of violence is moderately high, with nurses (67%) being most frequently being assaulted. Relative to other healthcare workers, emergency department (ED) staff face an exceptionally high risk for WPV, primarily due to open-door policies, a high volume of patients, and illness acuity. The purpose of this Doctor of Nursing Practice (DNP) project was to develop, implement, and evaluate an online module to improve ED nurses' knowledge, perceived safety, and confidence in identifying and managing WPV. This project utilized a pre- and post-knowledge assessment with an educational intervention (i.e., the video presentation) delivered in an online format. Via an online platform, participants were asked for demographic information, completed pre-knowledge and safety and confidence assessments. Participants viewed an informational video, and post knowledge, safety, and completed confidence assessments. A brief evaluation of the project's video was also completed. The project took participants one and a half hours to complete, and a nursing continuing education certificate was awarded as an incentive to participate. Change Theory has been utilized to explain interventions that improve nurses' perceptions of change in clinical practice. Change theory incorporates three concepts; driving forces, restraining forces, and equilibrium. Forces that push us in a director that results in a change to occur are driving forces. Change theory focuses on re-educating one's perceptions, beliefs, or attitudes. Lewin's change theory provided nurses with the direction in altering the old processes of dealing with violent patients to the new risk assessment method for potentially violent behavior (Shirey, 2013). One hundred and nineteen possible participants responded to the survey invitation. Of the 119, 44 completed the project requirements; thus, 77 participants were excluded from all analyses resulting in a final sample of 44 (N= 44). The majority of the final sample were female 37 (84.1%), mostly employed in the acute care or inpatient setting 37 (84.1%), and were nurses 40 (90.9%). Participants reported experiencing WPV at least once a day 27.3% of the time, 13.6% monthly, and 15.9% a few times a year. Some participants 16 (36.4%) reported they felt WPV increased during COVID-19. A significance difference (p= 0.00) was demonstrated on the knowledge assessments, increasing knowledge following the educational intervention. Scores on the safety and confidence assessment were improved, but not significantly. Project participants reported that 75% of the time, the incident of violence involved a patient, and 11.4% of the time involved a patient's family member. Participants further reported physical assaults 59.1% of the time, emotional assaults 68.2% of the time, and verbal assaults 45.5%. The Emergency Nurses Association reports that patients are the main offenders in all incidents of patient violence (97.8%) and visitor violence (92.3%), with the triage area (40.2%) being the most common area of WPV occurring. This project demonstrated that healthcare workers benefited from this educational module to improve their knowledge about WPV; however, changes in perceptions of safety and confidence to manage WPV need further research, especially those working in the emergency department.