ResearchImplementation of a Comprehensive Intervention to Reduce Physical Assaults and Threats in the Emergency Department
Section snippets
Methods
A quasi-experimental, repeated measures design was used to collect survey data from ED workers for 9 months before the intervention and 9 months after the intervention. The study was approved by university and hospital Institutional Review Boards.
Results
Participants were primarily female (n = 149; 71.3%), nurses (n = 117; 56%), and working in level I trauma centers (n = 130; 62.2%). The average age of participants was 37.3 years (SD = 10.5; range 20-65 years). Most participants (n = 179; 86%) had been either threatened or assaulted at least once during the 18 months of data collection. A total of 1333 events were reported on the Monthly Surveys: 346 physical assaults (26%) and 987 physical threats (74%). In addition, 832 Violent Event Surveys
Discussion
The purpose of this study was to test the effectiveness of a comprehensive WPV intervention. Although the study hypothesis was not supported, it is important to note that 2 of the intervention sites had a significant decrease in violent events. Of particular note was the intervention community-based emergency department, which had a significant, 50% decrease in assaults. Of the intervention sites, this facility enthusiastically supported, adopted, and took ownership of the WPV prevention
Limitations
The study had several limitations. The quasi-experimental design did not allow for randomization of participants; all eligible participants were included on a first-come basis, and thus the study participants may have generated findings that would have been different had other employees participated. In addition, reporting bias likely occurred at comparison sites. The employees and managers at these 3 sites frequently alluded to the fact that they were becoming more aware of and concerned about
Implications for Emergency Nurses
As reported by several other researchers, ED workers in our study did not report the vast majority of violent events, likely because of time constraints, fear of being blamed, and belief that doing so is a “waste of time.”13, 16, 17, 18 Also, the victims for a majority of violent events were not offered a debriefing, either formally or informally. These two findings together are consistent with other research findings that suggest that the ED culture accepts violence as “part of the job.”18 A
Conclusions
Despite our efforts to intervene, WPV by patients and visitors against ED workers continues to be prevalent. Given the diversity in the victims and perpetrators of ED WPV, ED leaders may need to adopt a universal precautions approach for the prevention and management of WPV prevention: assuming that all employees are at risk for victimization and that all patients and visitors could enact WPV. The lack of WPV reporting, program implementation, and postviolence care suggests that ED providers
Gordon Lee Gillespie, Member, Greater Cincinnati Chapter ENA, is Assistant Professor and Robert Wood Johnson Foundation Nurse Faculty Scholar, University of Cincinnati, College of Nursing, Cincinnati, OH.
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Cited by (0)
Gordon Lee Gillespie, Member, Greater Cincinnati Chapter ENA, is Assistant Professor and Robert Wood Johnson Foundation Nurse Faculty Scholar, University of Cincinnati, College of Nursing, Cincinnati, OH.
Donna M. Gates is Professor Emerita, University of Cincinnati, College of Nursing, Cincinnati, OH.
Terry Kowalenko is Professor, Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI.
Scott Bresler is Clinical Director/Division of Forensic Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH.
Paul Succop is Statistician/Research Professor, Division of Epidemiology and Biostatistics, University of Cincinnati, Cincinnati, OH.
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This research study was funded by grant No. R01-OH009544-01 from the Centers for Disease Control and Prevention–National Institute for Occupational Safety and Health (CDC-NIOSH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the CDC-NIOSH.