Date of Award

5-10-2017

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Julie A. Koch

Abstract

Patient/visitor violence against healthcare (HC) employees is a type of workplace violence (WPV) and considered a dangerous hazard within HC occupations (Bureau of Labor Statistics, 2015). Lack of recognition of the true incidence and underreporting of WPV may contribute to a false sense of security within a HC facility (HCF). Therefore, fully addressing the problem may be met with administrative resistance, resulting in poor employee perceptions of support and commitment for a zero-violence environment. A retrospective analysis was conducted on the HCF’s online incident reports, security request calls, and data from a previously deployed WPV employee survey. The emergency department (ED) was noted as having had the highest reported occurrence of WPV, as well as the lowest perception of facility commitment for WPV prevention. The purpose of this evidence-based practice project was to evaluate if the HC establishment of a multifactorial WPV initiative would improve ED staff perception and formal reporting of WPV within a Midwestern acute care hospital. The Kotter Change Model and Iowa Model of Evidenced-Based Practice facilitated project development. Organizational approval was obtained, education was completed, and a WPV policy was implemented as the foundation for the initiative. To evaluate the impact of the intervention, WPV surveys were administered eight weeks pre- and post-implementation; WPV online incident reports and security request calls were also tracked. A statistically significant difference in staff’s perception of commitment for WPV prevention was noted from pre-to post-implementation from administration (X2 = 19.011, p = 0.001), security personnel (X2 = 32.079, p < 0.001), and management (X2 = 28.420, p < 0.001). Approaching statistical significance (X2 = 9.363, p = 0.053), an improvement in ED staff perception of fellow co-worker commitment to WPV prevention was identified; 55.6% reported committed pre-implementation compared to 79.4% post-implementation. Increases in perception of support if the ED staff member was to become a victim of WPV was appreciated from administration (X2 = 28.166, p < 0.001), security (X2 = 20.775, p < 0.001), management (X2 = 38.320, p < 0.001), and co-workers (X2 = 16.462, p = 0.001). In addition, online reporting was more congruent with security call requests post-implementation, (1:34 pre-implementation vs.1:6 post-implementation). Thus, supporting the supposition that underreporting was occurring prior to project implementation and that post-implementation online reporting was more reflective of the actual incidence of WPV events. Overall, the data reflected the positive impact of the implementation of a multifactorial WPV facility initiative on staff’s perceptions of support for zero violence and staff’s commitment to reporting WPV events. But, the project initiated an organizational change that is continuing within the ED and will be expanded to other units within the facility and for other facilities within the parent organization.