Page 588 - Encyclopedia of Nursing Research

WORKPLACe VIOLenCe n 555

Control and Prevention/national Institute participation in training and aggressive
of Occupational Safety and health, 2002). behavior by inpatients on 27 inpatient wards
A 2005 national Survey of the Work and in a California State hospital and found that W–Z
health of nurses, a comprehensive survey wards with higher staff attendance at the
of a large sample of employed regulated training experienced lower rates of injury.
Canadian nurses (n = 18,676) found that Lehmann, Padilla, Clark, and Loucks (1983)
abuse by patients was related to being male, found significantly higher knowledge and
having less experience, working non-day confidence in trained staff.
shifts, and perceiving staffing or resources Runyan, Zakocs, and Zwerling (2000)
as inadequate, nurse–physician relations reviewed 137 articles mentioning violence
as poor, and coworker and supervisor sup- prevention intervention and found that
port as low (Shields & Wilkins, 2009). Lee, only 10 of the articles reflected a databased
Gerberich, Waller, Anderson, and McGovern intervention. All interventions took place in
(1999) found that among 105 nurses who health care: five studies evaluated violence
had filed a worker’s compensation claim for prevention training interventions (includ-
work-related assault injuries, the presence ing Lehmann et al., 1983; Carmel & hunter,
of security personnel reduced the rate of 1990), three examined postincident psycho-
assault, whereas the perception that admin- logical debriefing programs, and two eval-
istrators considered assault to be part of the uated administrative controls to prevent
job, having received assault prevention train- violence. All were quasi-experimental, with-
ing, a high patient/personnel ratio, working out a formal control group and with equivo-
primarily with mental health patients, and cal findings.
working with patients who had a long hospi- The health care workplace must be made
tal stay increased the risk of assault. safe for all health care workers through the
The one patient characteristic that has use of currently available engineering and
been singled out as a strong risk factor for administrative controls, such as security
violence is a history of violent behavior. A alarm systems, adequate staffing, and train-
number of studies have documented that ing. The Occupational Safety and health
a small number of patients are responsi- Administration (1996, 2004) published the
ble for the majority of assaults (hillbrand, Guidelines for Preventing Workplace Violence for
Foster, & Spitz, 1996). Drummond, Sparr, Healthcare and Social Service Workers, which
and Gordon (1989) examined an interven- described the key elements of any proac-
tion designed to identify patients with a tive health and safety program including:
history of violence and found that flagging management commitment and employee
charts of patients with histories of assaul- involvement, a written violence prevention
tive or disruptive behavior reduced assaults program, a worksite analysis, hazard preven-
against staff by 91%. tion and control, medical management and
Many psychiatric settings now require postincident response, training, and educa-
that all patient care providers receive annual tion, and record-keeping and evaluation of
training in the management of aggressive the program. Implementation of the guide-
patients. however, few studies have exam- lines has been found to be feasible within
ined the effectiveness of such training (Beech the mental health and social service work
& Leather, 2006). hurlebaus and Link (1997) settings (Adamson, Vincent, & Cundiff, 2009;
found a significant improvement in nurses’ Lipscomb et al., 2006). Findings from the inpa-
knowledge but no difference in confidence tient mental health workplace indicate that a
and safety after taking an aggressive behavior comprehensive violence prevention program
management program. Carmel and hunter is associated with a reduction in risk factors
(1990) examined the relationship between for violence (Lipscomb et al., 2006).