Date of Award
Projects: Open Access
Doctor of Nursing Practice (DNP)
Dr. Lena Hristova
Dr. Melissa Hutchinson
Background and Significance: Workplace violence (WPV) is any physical or psychological injury that befalls an employee in their place of employment during a work shift (Toon et al., 2019). Of the four categories of WPV type two and three WPV are the most common in the healthcare setting (Enos, 2020). Type two WPV occurs when a customer, client or patient becomes violent while receiving healthcare services (Enos, 2020). Nursing care often requires intimate contact with patients increasing vulnerability to attack through proximity to the perpetrator (Phillips, 2016). In 2016 WPV injuries in nursing were three times greater than all other professions and this rate of incidence continues to grow (The Joint Commission [TJC], 2018). Current statistics may not accurately describe the scope of WPV because it is underreported (Phillips, 2016; TJC, 2018). Reporting WPV events is not mandatory (TJC, 2018).
Problem and Purpose: Underreporting WPV results in flawed data which creates a barrier for planning prevention strategies (TJC, 2018). There is an increased need for data that accurately describes the characteristics of type two WPV to facilitate the establishment of sustainable prevention strategies (Arnetz et al, 2018). One significant barrier to collecting this data is the lack of formal reporting by hospital staff who have been victims of abuse (Phillips, 2016). There is a need for targeted staff education that may decrease anxiety and improve confidence when reporting type two WPV incidents in the electronic event reporting system. Better communication about type two WPV incidents may lead to the collection of reliable data to inform the planning of appropriate interventions and eventually produce a safer healing environment (Phillips, 2016). The focus of this project is educating healthcare staff to improve their confidence when reporting type two WPV incidents in an electronic reporting system.
Methods: This project used a single group pretest and posttest design, with data collected at the end of one month. After a convenience sample of employees working at Astria Hospitals completed a population survey and pretest assigned in the organization’s HealthStream, they could access an educational presentation focused on reporting type two WPV. Once staff finished viewing the educational presentation, they completed a Likert-type posttest that was identical to the pretest. These materials were created specifically for this project and were validated prior to administration with a literature table. The results of the three surveys were analyzed with descriptive and inferential statistics. Tool reliability was tested with Cronbach’s alpha and Factor analysis. The pretest and posttest results were tested for statistically significant changes with paired two tailed t tests and the Wilcoxon signed rank test.
Results: The project’s desired outcome was achieved and staff in two rural Washington hospitals self-reported statistically significant (p = <.001) changes in anxiety and confidence related to reporting type two WPV in the electronic reporting system after viewing an educational presentation. This research adds a new tool for the assessment of staff anxiety and confidence when deciding to report a type two WPV incident. Ninety-seven staff members completed the population and pretest surveys. Twenty-five respondents completed all three surveys. The results of the larger group (n= 97) were used to assess population characteristics, test the internal consistency of the Likert-type survey tool with Cronbach’s Alpha and Factor Analysis, and to assess the results of the fourth section of the Likert tool. Cronbach’s alpha confirmed the validity of the first fifteen questions of the Likert-type survey tool (0.931). The responses from the smaller population (n= 25) were analyzed to determine whether the clinical question was answered by comparing the pretest and posttest scores of sections 1, 2, and 3. The paired two tailed t test results for the three combined sections of the Likert-type survey indicate statistically significant changes from the pretest (mean (M) = 61.36, standard deviation (SD) = 11.04) to the posttest (M = 73.04, SD = 10.9), t(24) = -4.8996, p =<.001. These findings were confirmed with Wilcoxon signed ranks that resulted for the combined sections Standardized test statistic (Z) = 3.729, p =<.001, or reject the null hypothesis. The effect size (0.746) of the educational intervention was large.
Sustainability: This project produced educational material and surveys that are being used by the education department of Astria Hospitals. The educational presentation and surveys are resources designed for this Yakima Valley hospital system and its WPV safety committees to assist in compliance with state law.
Implications: By achieving the goals of this project, the Astria Health System has an improved chance of collecting accurate data regarding trends and patterns of workplace violence due to optimized staff communication with management via the electronic event reporting system. Data from the event reporting system was only collected through September 2022 for this project and it is unknown at this time whether WPV reporting rates increased after the project was complete. This is a topic for continued research. The mandated multidisciplinary safety committees in the Astria Hospital System require high quality information because it is the basis for determining appropriate interventions for three-year WPV safety plans. Additionally, continued staff reporting provides committees with current data so that they may assess the effectiveness of type two WPV prevention measures and adjust facility safety plans on a yearly basis.
Arnetz, J., Hamblin, L., Sudan, S., & Arnetz, B. (2018). Organizational determinants of workplace violence against hospital workers. Journal of Occupational Environmental Medicine 60(8), 693–699. https://doi.org/10.1097/JOM.0000000000001345
Enos, L. (2020). Stop violence in healthcare, workplace violence in hospitals: A toolkit for prevention and management. Oregon Association of Hospitals and Health Systems. Retrieved June 24, 2020, from https://www.oahhs.org/safety
Phillips, J. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine 347(17), 1661–1669. https://doi.org/10.1056/NEJMra1501998
The Joint Commission. (2018). Physical and verbal violence against health care workers. (Sentinel Event Alert, Issue 59). Retrieved June 24, 2020, from https://www.jointcommission.org/-/media/documents/office-quality-and-patient-safety/sea_59_workplace_violence_4_13_18_final.pdf?db=web&hash=9E659237DBAF28F07982817322B99FFB
Toon, M., Weaver, C., Fraiser, N., & Brown, K. (2019). Holding the line against workplace violence. Nursing, 61–63. https://doi.org/10.1097/01.NURSE.0000553279.11096.cf
Marsh, Jennifer A., "Workplace Violence: Workplace Violence Reporting in the Acute Care Setting" (2022). Doctor of Nursing Practice (DNP) Scholarly Projects. 48.