Implementing Violence Training to Reduce Workplace Violence amongst Registered Nurses and Healthcare Professionals

Underreporting

Underreporting affects every study involved with workplace violence (WPV) and continues to be a global problem. Babiarczyk, et al. [3] reported that in a survey of 1089 registered nurses, 54% stated that they had been exposed to non-physical violence, and 20% were exposed to physical violence. This study also reported that 70% of these cases had no action against them because the study group deemed them useless or insignificant. In a study conducted by Ramacciati, et al. [4], it was found that 90% of emergency department nurses experienced WPV in the past year. This high prevalence is regarded as part of the job and inevitable by these participants within the study [4].

Solutions to combat underreporting are continuously being addressed, trying to eradicate this ongoing inaccuracy in current data. Ramacciati, et al. [5] completed a study with 384 registered nurses who took part in a reporting system within a smartphone app. The study revealed that the application eased the reporting burden and overall increased reporting. Although this study proves that underreporting can be diminished with the help of technology, it is not enough to solve the problem altogether.

Factors Influencing Workplace Violence

One of the most understudied circumstances surrounding WPV is the factors that lead to the violence and the factors that happen due to the violence. Bayram, et al. [6] conducted a research study on 713 physicians that revealed that age, current position, level of experience, rotating shifts, the number of patients visiting the hospital, and the type of hospital all influenced the likelihood of being subjected to violence. Two studies both pointed out that one of the most influential factors involving WPV is the appropriate legislation that applies protection to healthcare workers, such as in Turkey and India, where the legislation is lacking [7].

When considering factors of violence, it is crucial to include the violence that can occur from colleagues. A study conducted by Najafi, et al. [8] reported that nurses’ lack of adequate clinical competence, poor stress management, and perception of nurses all lead to incidents of violence. This study points out the importance of examining the factors to develop better programs to prevent these incidents [8]. Ayakdas, et al. [9] completed a study on colleague psychological violence that pointed out the factors after the violence, such as being stressed, tired, eating disturbances, depression, changes in blood pressure, and social isolation.

Another study that evaluated Italian nurses saw similar effects when nurses had experienced WPV with sleep disturbances [10]. The study also saw an impact on the care they provide to their patients because of depressive episodes that lead to decreased work efficiency [10]. The information gathered from these studies allows individuals to understand that violence has consequences that are not just associated with humiliation or shame.

Implementation of Training

Implementing training will help healthcare professionals develop skills to prevent violence and decrease workplace violence. Al Ali, et al. [11] conducted a study that consisted of 100 registered nurses working across three shifts, which revealed a general concern among nursing staff about workplace violence. The concern confirms that there needs to be a prevention education program to help healthcare providers deescalate the problem [11].

Another study conducted by Ayhan, et al. [12] in a psychiatric setting found poor management of violence. There was a lack of confidence in their de-escalation skills, and helplessness seemed to emerge, making the participants feel the only option left was physically and chemically restraining the violent perpetrator. This reveals a more significant need for training to help gain confidence in healthcare providers to ensure their safety and their patients. Story, et al. [13] conducted a study that implemented workplace aggression and violence prevention training program to 43 participants. This study showed that with implementing the WPV prevention program, awareness of WPV, recognizing and preventing aggression or violence, staff’s confidence increases dramatically [13].

Understanding behavior management techniques increases and gives the participants more confidence to perform these techniques in practice. A study completed by Al Shaban, et al. [14] revealed that the implementation of a WPV training program increased the confidence in the staff and demonstrated to the hospital administrators how vital this program was to continue for the health of their team. Ming, et al. [15] conducted a study with the implementation of simulation violence training that significantly increased the confidence of the nursing staff after its implementation. The study showed progress for future activities such as incorporating simulation teaching, continuously adjusting the program according to current research, and developing an online program to ensure it is flexible for all participants.

Effectiveness of Evidence and Impact

Current research points to evaluating the effectiveness of the evidence associated with training for workplace violence that has been discovered thus far and the implications it brings to the current nursing staff. Spelten, et al. [16] completed a study that evaluated the effectiveness of implementing WPV training and the flaws that come with these programs. This study revealed that although the training was effective in helping healthcare providers feel confident in their ability to manage a violent situation, it did not adequately address the factors associated with preventing the problem from initially escalating.

To further explain the need for effective research, a study was completed by Lamont, et al. [17], which describe the implications that if WPV training programs were taken seriously in all facilities, then the administrative team may be able to address recruitment and retention, sickness, absence, and burnout issues because these factors would be decreased with happier and healthier employees. The most significant impact for change is the amount of quality evidence, so when looking at WPV, there need to be more quality studies completed to ensure that we can eradicate WPV.

Implications for Future Practice

The implications of workplace violence for the current and future healthcare professionals are astronomical. Although bedside nurses are thought to be the only victims of workplace violence in the healthcare industry, other healthcare staff including Nurse Practioners are still at risk for workplace violence due to their contact with many different patients and diagnoses [18]. This issue has recently gained national attention and has introduced risks of being a healthcare worker, so more is to explore. The healthcare community has the ability and opportunity to conduct successful studies to provide a significant amount of evidence that demonstrates the violence that healthcare workers experience. The evidence allows individuals to form legislation and make changes for generations to come.