Date of Award

Spring 6-2022

Scholarly Projects

Projects: Open Access

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Lena Hristova

Faculty Reader

Melissa L Hutchinson

Executive Summary

Executive Summary

Background and Significance

Compared to all other industries in the United States, healthcare professionals are at the greatest risk for experiencing work-related violence (Cafaro et al., 2020; U.S. Bureau of Labor Statistics, 2020). Moreover, patient-to-staff violence, also known as Type Two Workplace Violence (Type 2 WPV), has the highest prevalence to healthcare employees in the past decades (Nowrouzi-Kia et al., 2019). Increasing incidence of Type 2 WPV impacts the health status of medical workers mentally and physically and generates substantial costs to organizations and the society (ILO/ICN/WHO/PSI Joint Program on WPV in the Health Sector, 2002). Thus, there is a need to offer initial training to all healthcare workers to strengthen the management skills in response to the increased prevalence of Type 2 WPV (Adams et al., 2017; Occupational Safety and Health Administration [OSHA], 2015).

Problem and Purpose Statement

Patient-to-staff violence has a large-scale impact on employees’ safety, physical and psychological well-being (OSHA, 2015). To minimize the prevalence of Type 2 WPV in the healthcare industry, constructive educational interventions are needed to enhance healthcare workers’ knowledge, skills, and competence when managing aggressive behaviors displayed by patients (Michelle A, 2018; Washington State Department of Labor & Industries, 2015). Introducing a Type 2 WPV prevention training program would improve employees' attitudes and confidence levels when facing aggressive behaviors displayed by patients. The purpose of the DNP project was to initiate a Type 2 WPV prevention training program designed to enhance healthcare workers' ability to recognize and manage patient aggression by introducing two validated violence risk identification tools. By initiating an educational intervention, employees would be able to identify violent behaviors and avoid hazardous situations. Therefore, decreasing the long-term incidence of Type 2 WPV.


The prevention intervention included a trial educational session and a single group pre/posttest design that measured changes in participant' attitude towards patient aggression. All surveys were conducted by electronic format (Google Form) and participants were prohibited from accessing the PowerPoint educational session until completion of the pre-educational survey. The PowerPoint presentation explained the two validated risk identification tools for common characteristics of violent behaviors: (1) the Aggressive Behavior Risk Assessment Tool (ABRAT), and (2) the Staring, Tone, Anxiety, Mumbling, and Pacing (STAMP). The pre/posttest utilized an evidence-based method to assess participants' attitude change before and after the educational session, the Management of Aggression and Violence Attitude Scale [MAVAS] (Duxbury et al., 2008). Additionally, a self-rating confidence measure (0-10 scale) questionnaire was added to evaluate self-efficacy improvement post-intervention. The data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, adopting a significance level of p < .05. Paired t-tests were used to evaluate the impact of the educational intervention based on data from the two surveys.


The project was successfully implemented in a community hospital and provided valuable direction in the development of a comprehensive Type 2 WPV prevention training program. Results were measured by a single group pre-and post-intervention surveys, data analyses, and respondents' self-rating confidence level towards violence management. The total number of analyzed samples were 28 (N=28). The outcomes measured displayed an improvement in staff attitudes toward the management of patient aggression after the educational intervention. A statistical significance changed: t(27) = 3.625 (pM= .30, SD= .13, N=28) to the post-intervention survey (M= .36, SD= .11, N=28). In the post-intervention survey, a result showed that participants' confidence level raised by 10% towards patient aggression.


The educational material will be maintained through the Employee Continual Learning system for newly hired orientation as directed by the administration of the hospitals' safety committee. Additional recommendations included initiate simulation-based training, piloting the risk identification tools, ABRAT into the admission process for aggression perdition, and encouraging Type 2 WPV reporting protocols.

An additional oral report and recommendations were presented to the hospital's safety committee. The next step will include sharing project outcomes with Washington State Hospital Association (WSHA) and discussion for dissemination plan of the program to other hospitals members of WSHA. The current COVID-19 pandemic could hinder the execution and should be considered as the barrier for timely implementation in the sustainability plan.

Implications for Practice

Healthcare workers are at high risk and have a greater chance of being victims of violence in the US. Currently, WPV related training programs include all types of WPV in one package. The findings suggest that a specific educational program focused on Type 2 WPV prevention and management is needed in every organization, which is also recommended by OSHA. The training equips healthcare workers with the knowledge of recognizing violent behavior and initiating proper interferences to perpetrators in time to de-escalate violent situations. A violence prevention program would prepare healthcare workers with the necessary knowledge and confidence to support a safe working environment, increase job satisfaction for all front-line healthcare workers, and provide a quality patient worry-free.


Adams, J., Roddy, A., Knowles, A., Ashworth, J., & Irons, G. (2017). Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence. 34(3), 11.

ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector. (2002). Framework guidelines for addressing workplace violence in the health sector. ILO.

Cafaro, T., Jolley, C., LaValla, A., Schroeder, R., & Repique, R. J. (n.d.). Workplace Violence Workgroup Report. 3.

Duxbury, J., Hahn, S., Needham, I., & Pulsford, D. (2008). The Management of Aggression and

Violence Attitude Scale (MAVAS): A cross-national comparative study. Journal of Advanced Nursing, 62(5), 596–606.

Michelle A, D., Michelle A. ;Kissinger,Samuel. (2018). Occupational injuries and illnesses among registered nurses _ Monthly Labor Review_ U.S. Bureau of Labor Statistics.pdf. U.S. BUREAU OF LABOR STATISTICS.

Nowrouzi-Kia, B., Isidro, R., Chai, E., Usuba, K., & Chen, A. (2019). Antecedent factors in different types of workplace violence against nurses: A systematic review. Aggression and Violent Behavior, 44, 1–7.

Occupational Safety and Health Administration. (2015, December). Workplace Violence Prevention and Related Goals: The Big Picture.

Included in

Nursing Commons