NURSING Evidence-Based Practice Survey Summary Christina Graham Grand Canyon University Evidence-Based Practice Project NUR – 699 June 17th 2017 NURSING 2 Violence Against Nurses in the Workplace A review of the organization's readiness to improve the Evidence-Based Practice reveals willingness of the staff but the inadequacy of skills and equipment needed to actualize the plan. The organization is therefore ready to implement an Evidence-Based Program since the staff will support it and the initiative will yield results. The review shows that some of the valid limitations that the organization will have to address are the lack of knowledge and skills that pertain to the Evidence-Based Practice, the lack of staff to work in the department and the lack of a clear framework for adopting the EBP care. An EBP plan will not only seek to increase the clinical practice environment, but it will also care for the needs pf the nurses and the patients. The EBP program will also focus on the issues of clinical inquiry that enables healthcare facilities to keep the record of performances of the staff and evaluate the performance. The survey focus was on identifying the knowledgeability of the EBP program by the staff and the capacity of the organization in accommodating the changes if they were to be implemented (Patter & Schaffer, 2009). The research shows that 64% of the staff are aware of the EBP program, but the implementation in the organization is at 34.5%. The initiative by the organization will be required to increase the use of the EBP program by staff concerning training, staff hiring and provision or equipment, and supplies needed to execute the program. The organization can achieve this by budgeting for the program in its initiatives and ensure there is a running department that keeps records of the findings and surveys conducted timely. The staff should also be actively involved to keep the practice running efficiently. The information can later be used as a monitoring and evaluation tool in the performance of the organization. The data can be used to keep clinical records that are relevant to protecting both nurses and patients in the case on eventualities that may need verification based on evidence practice. NURSING 3 Introduction Violence in the workplace is increasing in the healthcare services across the country, and the nurses perceive the violence to be part of their job (Park, Chao & Hong, 2015). The acceptance can be attributed to their inability of nurses to differentiate what is workplace violence (WPV) and the ways in which the nurses can be helped. The emergency room (ER) also known as the Emergency Department deals with emergency patients without an appointment who are in need of urgent medical care (Gacki et al., 2009). The nurses in the Emergency rooms experience a variety of patients with illnesses and injuries of diverse nature, and some of the patients can be a threat to the nurses. The threats may be attributed to the mental status, lifethreatening experiences, pain, drug induced psychosis, and trauma among others. The ER operates on a twenty-four our system, and therefore the nurses should be safeguarded from the paranoid patients to prevent them from cases on WPV. Over the years there has been an increase in the cases on WPV especially among the nurses, and most of it goes unreported (Park et al, 2015; Fernandez, et al., 1999). According to the CDC report on occupational traumatic injuries, one in five violence cases was reported. The National Institute for Occupational Safety and Health (NIOSH) together with the CDC created a network, Occupational Health Safety Network (OHSN) that would collect data on the violence cases to help reduce the incidence and prevent the situation (Ahmed, et al., 2015). The OHSN network first determined what is considered violence and they categorized it into fatal and nonfatal injuries to help is determining the degree of violence. The research dated between 2012 and 2014 based on 112 health facilities showed that WPV increases among nurses and nursing assistants compared to other professions. The study also revealed that 99% of the cases reported on injuries were physical assault (BLS, 2014). Other forms of assault identified included verbal NURSING 4 assault and destruction of property. Among this number, 13% of the nurses reported the identity of the assaulters, but the rest withheld the information. The study also showed that patients perpetrated 95% of the assaults. The staff under the ER room experience high levels of violence because of the uncertain state of the patients (Fernandez, et al, 1999) thus they are ideal for assessing the WPV risk in healthcare. Overall, the Bureau of Labor Statistics data on violence shows nursing as the profession with high-risk cases of WPV. The studies, therefore, are necessary to validate the trend that WPV is high among the nursing professional with a focus on the ER nurses as they handle patients with higher chances of not cooperating. The study will evaluate the OHSN framework and its use in nursing facilities, evaluate the cases of abuse and their perpetrators and also seek to establish the extent of the assault on the nurses and if it has impacted the staff in any way. The study also seeks to identify the role of health officials on the management and prevention of WPV and the measures in place to avoid WPV. Study Purpose The study will evaluate the OHSN framework and its use in nursing facilities to reduce WPV, evaluate the cases of abuse and their perpetrators and also seek to establish the extent of the assault on the nurses and if it has impacted the staff in any way. The study also seeks to identify the role of health officials on the management and prevention of WPV and the measures in place to avoid WPV. Objective To evaluate the role of Evidence Based Practice in the assessment, prevention and management of work place violence. NURSING 5 Specific Objectives • To measure the WPV cases in selected health facilities using the OHSN framework • To evaluate the role of key stakeholders in WPV • To calculate the trend of WPV in the selected facilities • To assess the impact of WPV on the affected • To study the existing policies and assess the need for improvement Rationale The study will help establish the rate of WPV in the study area with a focus on the type of assault and the impact it has. The study also seeks to establish the consequences of the offenders and the approach of the management is preventing the WPV. The research will establish the use of evidence-based research on preventing WPV and its ability to influence decision making in the healthcare facilities. Workplace violence has shown a growing trend, especially among nurses. The research aims to evaluate the types of violence common in the emergency room, the rate of occurrence, the impact of the violence and ways the violence can be prevented. The research targeted emergency room nurses through questionnaires that they were expected to fill. The response is then subjected to an analysis to get the existing trends to help inform of the possible ways to end violence against nurses. Keywords: Violence, Nurses, Emergency Room, Occurrence The violence in the workplace towards nurses has shown an increasing trend globally. The U.S Bureau of Statistics report on the workplace violence shows an increase of 110 percent assault in hospitals. Out of the reported cases of hospital assault, 75% of the casualties are nurses NURSING 6 especially those on the Emergency Room, ER (BLS; ENA, 2011). The rising patterns call for attention to the issue in a bid to reduce the impact of the violence and protect the nurses. This can be achieved if the source of the violence can be determined, understand the existing policies in handling violence cases to help establish what works and what does not to recommend areas of improvement. Several studies point that violence may be inevitable due to the instability of the patients especially mentally and emotionally, but prevention techniques can be applied to reduce the effect (Potera, 2016: Gates et al., 2011). Based on the research on scholarly journals, there is no federal regulation articulated for handling workplace violence. The study, however, reveals that several states have adopted ways of handling violence by promoting report of incidences and training nurses on de-escalation techniques. An example is California that passed guidelines in October 2016 for health employers to implement prevention plans against the violence of their staff based on the employee feedback mechanism (BLS, 2016). Other actions are being taken by individual health facilities such as Providence Hospital in Massachusetts that trains its staff on self-defense skills. Such initiatives help curb the issue, but a nationwide plan is needed to harmonize efforts to end workplace violence. The U.S Department of Labor is working towards getting a universal federal approach, and the study can help in identifying methods that can work effectively and help prevent violence (BLS). Workplace violence affects the employee, the patient and the employer in the health sector. The nurse involved experiences physical injuries, psychological trauma, insomnia, and fear of patients (Gates et al., 2011). Their impact translates to absenteeism in the workplace, job dissatisfaction, leniency in offering care and diminished morale. The impact translates to the employer regarding costs, litigation, compensation, damages to property, offering medical care NURSING 7 and psychological care. On average employers, spend about $31,643 on cases handling registered nurses and about half for licensed practicing nurses (Potera, 2016). The patients also suffer as absenteeism decreases the effectiveness of service delivery, they experience negative attitude from staff; however, there is little evidence supporting this effect. The research, therefore, aims to explain the effect of workplace violence towards nurses by patients affect their relationship and recommend ways that can help prevent the assault cases. Research Method The process adopted will use a research design template to survey the population. The surveys will be informed of questionnaires with both open ended and close-ended questions to help determine the rate of workplace violence, the impact of the violence on the nurses, how the issue was handled, and the effectiveness of the method and alternative solutions that can be adopted. The questionnaires will be sent to a stratified random sample of emergency room nurses in selected hospitals through emails. The nurses will be expected to specify their level, age, experience, effect, and ways they can propose to help end workplace the violence. The response will then be subjected to a Likert scale to evaluate the impact of the response to violence against nurses. The solutions will also be subjected to the same review to establish what works and what is perceived to work for further investigation. The Likert scale gives weight to the answer, and it subjects it to weighted analysis on which answer has more influence than the other does (Gates et al., 2011). The findings will help develop a recommendation plan that can be used to inform on the issue of workplace violence. Proposed Solution/ Recommendations • Creation of federal regulations to help prevent workplace violence towards nurses. NURSING • 8 Provide more funding towards research on violence against nurses to help in understanding causes and prevention measures. • Creation of a database that reports on the nurse's performance and violence cases that can be used to make sustainable solutions to the trends identified and the action taken. Strengths • The findings of the literature will be evidence-based therefore making it credible, and it will help in informed decision-making • The research follows research methods to support the reported trends and to show the severity of the violence trends. • Information is acquired from specific actors thus making it a strong evidence. • The research process is conducted across several hospitals without being there physically thus in increases the scope of analysis that reduces bias. Limitations • The study may not be clear about the impact of violence on productivity and work performance as other factors also influence the traits such as • The validity of the information is subject to the respondents that mean a biased respondent affects the quality of data collected. • Lack of response from some of the respondents may reduce the population sampled. The review of literature shows that workplace violence is higher among hospital workers with more effect on nurses. The research study is focused on ascertaining the growing trend of NURSING 9 violence against nurses with a case study if the emergency room nurses. The sample is identified from the ER category and a questionnaire is administered with the relevant questions to the research. The response will then be evaluated using a Likert scale to establish the weight of the factors and their level of influence. Workplace violence against nurses is a rising trend that needs to be addressed using sustainable approaches. Several organizations and states have taken up the initiative, and through case studies, solutions have been proposed that aim to prevent and reduce workplace violence. Some of the approaches adopted are the development of policies that protect nurses, training on workplace violence, development of systems to deal with violent cases, the creation of a database on violence cases and promoting an organizational culture that protects the nurses from being prone to violence. The America Nursing Association has developed a bill that expects healthcare centers to create violence protection programs aimed at creating awareness and protection measures (Potera, 2016). The policy acts as a guide to the development of systems that will work to prevent workplace violence and deal with the issue. The Department of Labor is also working towards developing a federal law that will be adopted by states on how to prevent nurses from workplace violence (BLS). A universal approach will enhance safety since currently; piecemeal actions are being adopted by facilities independently. The policy will give a framework that will guide all facilities promoting a common goal, and the implementation will be a requirement. The initial process of developing the policy may be costly, but once it is a law, implementation will be decentralized to health facilities. The approach will safeguard the nurses, maintain professionalism, and help the patients to reduce violence cases. NURSING 10 Training the nurses on workplace violence creates awareness on threats and ways to prevent violence. A study on ER violence cases revealed that nurses are not prepared for violence at work, and therefore most of the victims are unaware of what violence is and how they would go about seeking help (Gates et al, 2011). The approach will educate both the administrators and the nurses on handling workplace violence and preventing incidences that may escalate to violence with an aim to reduce the risk. Health facilities in Massachusetts have adopted the training approach offering self-defense classes for their staff (Potera, 2016). The program's costs of implementation are moderate as training can be done on selected people in states who are then expected to pass down the training to others. The approach equips the healthcare staff with the potential threats and the reality of workplace violence, and the leadership is expected to identify ways to manage it within their facilities. This will improve on quality care and enhance efficiency in managing violence. The approach will make it easier to report cases of violence, and the ideal action will be adopted. The approach assumes that all facilities face a common case of violence; thus, the policy is uniform for all health centers. The approach to developing a system to report workplace violence will be well adaptable with the creation of a database to record cases of violence. The database will record the nurses affected and the patients who carry out the attacks. In creating a database, there will be evidence that will help in decision-making, as the trends will show areas with high violence cases for action and patients will be flagged off every time they visit the facility (Gates et al., 2011). The approach can also help to develop a way to alert security and ways to keep violent patients calm. It, therefore, is a way of improving care given and promoting efficiency in violence management. The approach may be costly at first due to technology needed, which is the NURSING 11 software and equipment. The approach may also not solve the issue at first, but it will help in making informed decisions based on the database records. Another approach is the adoption of an organizational culture that will reduce workplace violence. This may include workplace designs that do not isolate patients with nurses to avoid violence cases. In some cases, some areas will have extra security to ensure nurses are protected, and there is swift response for aggressive patients. Other cases require more than one nurse attending to the patient to reduce the risk. Such systems help to safeguard the staff from threatening situations, and it will promote professionalism and improve patient care as well. The organization culture will also make incidence reporting easy for it to be investigated and legal action taken as a way of promoting nurses safety in the workplace. The process is not expensive as it is leadership based and it is passed from the leaders to the employees. The culture can be drafted into healthcare guidelines to ensure its sustainability even under new leadership the culture will remain (Potera, 2016). The approaches adopted by the health facility may change the system of running things, but some of the may be adjusted based on monitoring practices based on evidence recorded in the database. Patients with high violence tendencies need to be handled by more than one nurse, and they should not be isolated but put in open areas to ensure safety. The security guards may also be trained on behavioral practices to know how to deal with the violent patients. The training will improve the knowledge of violence, the openness of reporting violence and adoptions of the preventative action. Adoption of the strategies will create awareness on the rising trends of workplace violence, it will help the management understand what violence entails, it will equip nurses with skills to prevent violence, and it will promote action to end violence towards nurses. NURSING 12 The evidence-based research shows that violence against nurses in the workplace has increased over time. Action should be taken to reduce the violence and these calls for an implementation plan to achieve the set objectives. The diffusion of innovation theory by Roger Everett is an ideal model to adopt in eradicating workplace violence as it sets out stages of adoption of the plan leading to gradual improvement and changes. The theory of diffusion of innovation depicts a process in which people embrace a new practice, idea, or philosophy over time (Rogers, 2003). The model maps out the stages of adoption of the idea from the initial stages as denoted by innovators until the idea is diffused to other people until the final stage of laggards. The model is ideal for the spread of technological innovations as it is communicated through social systems. The model takes place in five steps that can be used to develop the evidence-based plan aimed to reduce workplace violence. The key channels are knowledge, persuasion, decision, implementation, and confirmation of changes (Rogers, 2003). The procedures work with several elements to achieve the desired effect. They include are innovations, adopters, channels of communication, time, and the social systems (Meyer, 2004). Knowledge stage is also known as the awareness stage exposes the individuals to the innovation or idea. In this stage, the approach taken would be to bring awareness that workplace violence towards nurses is a rising trend. In this phase, the stakeholders will be informed on the trend of workplace violence, evidenced by statistics and this will prompt them to seek further knowledge on the issue. The process will involve sending circulars, advertisements, posters, and letters to healthcare centers to inform the staff of workplace violence. The step, however, offers little information on the issue but it prompts the recipient to seek further information as it creates interest in the topic. NURSING 13 The next stage is Persuasion stage also known as Interest. The stakeholders become interested in the idea, and they seek to get additional information on the topic. The evidencebased research will provide the information on violence statistics, the forms of violence, and the impact it has on all the affected parties. The step should persuade the stakeholders to view violence as a major issue of concern that affects the quality of healthcare given (Jordana, 2011). The stakeholders will understand the findings of the results and be prompted to take action to deal with the rising trend of violence. The step can be enhanced using victims to persuade the actors that there is an urgency for immediate action. Decision-making step also known as evaluation stage follows the persuasion stage. In this phase, the stakeholders are challenged by the information, and they will be seeking a way to solve the violence. The evidence reported in the study will inform the decision process, and the best practice will be presented with an aim to plan the order of decisions to be undertaken. The decision process also looks at other future trends, and they seek ways to prevent violence. The decision-making process is left to the leaders in the health sector, and once the decision is made, implementation will be easily followed. Implementation stage follows decision-making. It is achieved once the leaders have made full use of the information received and identified the need for action. The process will involve the implementation of the decision made in the order perceived. The actors specified within the given period will implement the process, and they will observe the process until completion. The implementation plan outlines the estimated time, the costs, the actors, and the expected outcome at the end of the procedure (Jordana, 2011). The ways to deal with workplace violence are adopted for the health facilities through training, adoption of technology that enables database creation and monitoring of violence related incidences. NURSING 14 The final step is confirmation or the complete adoption stage. The process is achieved by assessing the impact of the implemented action plan. The outcomes are assessed to evaluate if the desired effect is being achieved then the program will be rolled out in the whole facilities as well as in other facilities. A positive outcome leads to the adoption of the plan as an adequate and sustainable approach in dealing with workplace violence against nurses. The outcome will also improve on the policy formulation process, as the adopted approach is viable. The adoption of the diffusion of the innovation process in dealing with workplace violence will work towards informing the stakeholders of the issue and bring them on board to tackle the issue. The elements that make the process effective are innovations, adopters, channels of communication, the time frame, and the social systems. The elements work with the stages of the model to reduce workplace violence. The procedure flows from one stage to another, however, its iterative meaning that one can go back to the previous step if the desired outcome has not yet been achieved. The procedure, however, builds over time from a point on unknown to fully implementing and monitoring the process. It is an ideal model for dealing with workplace violence since people have no or limited knowledge of its existence and what it means. The suitable method adopted to deal with workplace violence is the Diffusion of Innovations by Rogers. The method is implemented in five distinct phases guided by the elements of time, resources, communication tools, idea, and social systems (Marsh & Sharman, 2009). The first approach is spreading the knowledge on workplace violence. After informing actors on the idea, innovation is shared on how the changes can be made. The third step will involve making a decision and then followed by implementation and confirmation. The confirmation step will assess the model and applied action to evaluate the outcome. This will help determine if a right choice was made in dealing with the issue. Therefore the solution to NURSING 15 workplace violence will be based on creating awareness, identifying actors and train them on approaches to reduce workplace violence, offer assistance in the implementation stage and finally monitoring of the adopted innovations. The initial process to commence the training will require a letter from the America Nursing Association, ANA, and the state health department as it will seek to improve the quality of healthcare workers (Gates et al., 2011). A letter will be written to the respective department for approval on training, and once the state approves, the identified health centers will commence the training and implementation process. The process will involve a session with head nurses in health centers to identify cases of workplace violence and it will involve sharing the idea with them before rolling out the implementation plan. The statistics will then be used to persuade them into addressing the concern and get involved in the initiative to end workplace violence. Centers identified with high violence cases will be rolled out first, and the others later as the level of implementation vary. The appropriate time for implementation of the process is about six months, as training will be done in sessions and inclusive of all sectors. The process will require resources to accomplish the tasks. They include human capital, adopters, fiscal, and tools that will support the implementation. The adopters will include health center head, healthcare staff, the state health department, and federal government health representatives. The adopters will receive persuasion and training from the research team, ANA’s officials who have been actively involved in the research process and identified victims of workplace violence. The fiscal resources will be used for purchasing equipment, organizing transport, purchasing training apparatus and facilitating trainers (Moja et al, 2014). The tools used for the implementation include flyers, behavioral education, and illustrations. The resources will work together to educate on and provide solutions for workplace violence towards nurses. NURSING 16 The implementation program will be based on the adoption strategies reached from the training. The confirmation stage will be conducted using the monitoring and evaluation strategy to the action and its outcome. Several tools will be used to study the success of the programs; they include questionnaires targeting the nurses to evaluate the training, and action taken is effective. Interviews will also be used to assess the overall quality of health care given by the facility, and it will also target patients. Performance will also be tested using a Likert scale to assess the benefit of the program on the quality of healthcare. Similarly, an evaluation of reported cases of violence after training will be assessed to depict changes in trend. This means a decreased level of violence cases will show positive gains from the program implementation (Marsh & Sharman, 2009). Overall, the program is meant to help the healthcare centers, and therefore the health supervisors to ensure the impact of the study is well implemented and sustained must conduct training. The nurse heads will be trained as well as department leaders to ensure the sustainability of the program. The health center is also expected to keep a record of violence cases, reported outcome from performance tests, and trends of violence. The data will be used to analyze the outcome of the program, identify areas that need more input and it will assist in planning or fiscal allocation in reducing workplace violence (Gates et al., 2009). The IT department in the health center should keep the data and ensure all reported cases are input in the database for further analysis using statistical software. Patient satisfaction level will be filled, and input in the system to monitor the improvement in the quality health scare given. Challenges Expected The first challenge expected is to involve all healthcare givers in the area to attend the program, and this will be resolved by involving the state to summon the head nurses to a NURSING 17 conference. The conference will be a platform for introducing the innovation. Facilitators will be trained before the conference to ensure they understood the current situation and desired approach of the program. Costs will also be a limiting factor in some facilities, but with the help of the state government, donor organization, and healthcare associations, the program will receive funds to initiate the first phase that will be used (Moja et al., 2014). The process will be implemented in phases with expectations that selected health centers shall complete successfully. Any unexpected outcomes will be reviewed, and a different approach is taken to achieve the desired results. After the implementation, the successful programs will be enlisted under the ministry of health, and they will receive funding for a while until the health centers organization culture embraces techniques to prevent workplace violence. Programs that are slow to yield the expected results will experience a review on the challenges and better approaches adopted based on the uniqueness of each case. The facilities will experience extended time, more training and reviews will be based on the proposed amendments. Health centers that will not show any progress will be reviewed through a case study to identify causes and propose a sustainable approach to the identified issue. Health facilities with no record of violence will be discontinued from the program; however, they will undertake the basic training until the facility adopts measures to prevent workplace violence. The project will be assessed in phases to reduce the cost of implementation so that the program will be sustainable in the end. The Evidence Based Practice, EBP, in handling workplace violence will be implemented and gauged based on an evaluation plan. The plan is set to determine the role EBP plays in the monitoring, prevention, and handling of work related violence towards emergency room nurses. The approach focuses on establish the trends associated with workplace violence in the study NURSING 18 cases, evaluating who are the key stakeholders and the role they have in eliminating violence cases, assessing the impact of violence on all the stakeholders, and to evaluate existing policies on dealing with workplace violence, evaluating gaps and proposing recommendations that will improve the policies (Melnyk et al., 2012). The approaches adopted in achieving the objectives are diffusion of innovation model that will assess all factors and guide the decision making process successive. Evaluation of Method The method identified for collecting data outcome is questionnaires, performance evaluation, and interviews. The process seeks to have feedback from the stakeholders on the changes experienced once the EBP approach has been implemented in the management of violence. The methods allow participation from all stakeholders irrespective of their geographic boundary. Questionnaires feedback is compared to the initial data collected before implementation to assess changes that can be determined through regression. The questions are guided by the researchers and targets towards evaluating the implementation program in place and if the nurses benefit from the program. The questions are also tailor made based on the level of implementation, and it will assist in knowing key areas of the program that was effective and those that were not effective. The open questions allow the nurses to give opinions on ways to adjust the program since they are the implementers and they have firsthand encounter with the violence (Hack & Gwyer, 2013). Questionnaires also act as evidence for monitoring changes over time. Questionnaires are valid if they are filled by the stakeholders without bias and honest. They are also easy to send making them available readily for use. The performance evaluation based on both nurses and patient feedback. The method aims at evaluating benefits of violence training and the impact it has contributed to the performance of NURSING 19 the staff in healthcare. Though performance may not be assessed only by workplace violence, assessment after training and program implementation may suggest a relationship exists. This relationship can be tested in the questionnaire and interview evaluation. The failure of any progress may show other limiting factors in the health center that may need to be evaluated. Similarly, a negative trend in the performance may show a negative approach that can be netted in the questionnaire for strategic implementation. The performance method depends on the records taken to the hospital, patient review and the job satisfaction of the nurses thus to make it holistic all these factors will be considered (Patton, 2008). Interviews are also relevant for key stakeholders such as nurse heads who can assess the improvements in the quality care given and the cases of violence reported. The interview is structured based on the key informant, and the level of information given depends on the interaction with the plan. Interviews help in assessing feedback from individuals who interact with the program frequently and they have the ability to give a review based on the assessment of the staff, the facility for the state. Interviews are also custom made based on the interviewer, and therefore they remain objective, and they save on time (Hack & Gwyer, 2013). The procedure is however limited since the validity of the information is based on the interviewee response. To curb the bias of information, facts may be needed to validate the findings such analysis on patient satisfaction or job satisfaction levels. In the case that the method does not yield the expected outcome, a different approach will be taken to validate the findings. The process will also strategize and identify why the program is not effective based on a sample study. The review may assist in identifying the challenges, and it will help suggest for proposals based on the available evidence. Failure also may require an evaluation of other factors that may influence the outcome such as organizational culture and NURSING 20 attitude. The program can also be interactive to allow different stakeholders to share their opinions and this will build a synergy for a common cause that is to end work-based violence towards the ER nurses (Melnyk et al. 2012). The outcomes of the research will help in the development of a policy that will address the concerns of workplace violence in the present day hospital. This will be based on the outcome of the study on the rate of violence, forms of violence, ideal approaches in handling violence and training needed to reduce violence. The findings will also create room for more research on factors that trigger workplace violence that will lead to remedying of some cases especially if they are not health related. The study can be used to train stakeholders on preventative measures that will regulate the emergency room violence, and it will help the nurses feel safe as they continue with their work. Conclusion The plan adopted evaluates the issue of workplace violence based on the stakeholders involved, the time, mode of access to the stakeholders and the expected outcome. These factors have influenced the model adopted, the approaches were taken and the possibility of implementation. Questionnaires and interviews can be achieved easily even among stakeholders across different geographic spaces by the use of modern technology. Performance evaluation is acquired from health center assessments, and it is therefore based on individual health centers the methods are easy to implement, analyze, and develop a fact-based research and be able to support the outcome through statistics. NURSING 21 Reference Ahmed. E. G., Loren C. T., Sara. E. L., Kelly. V., Raymond. F. S., William. M. R., Susan N., & Sprigg. S. M. (2015). Occupational traumatic injuries among workers in health care facilities — United States, 2012–2014. Morbidity and Mortality Weekly Report (MMWR), 64(15); 405-410. Bureau of Labor Statistics. (2013) Survey of occupational injuries and illnesses: nonfatal (OSHA recordable) injuries, industry incidence rates and counts. Washington, DC: US Department of Labor, Bureau of Labor Statistics, Safety and Health Statistics Program; 2014. Available at www.bls.gov/iif/oshwc/osh/os/osch0052.pdf. Emergency Nurses Association, ENA. (2010). 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Park M., Cho S. H., & Hong H. J. (2015). Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment. Journal of Nursing Scholarship, 47 87-95. Patter, B. V., & Schaffer, A.M. (2009). Organizational Readiness for Evidence-Based Practice. The journal of nursing administration, Vol. 39:2, pp. 91-97. NURSING Patton, M. Q. (2008). “Utilization-Focused Evaluation, 4th ed”. Thousand Oaks, CA: Sage Publication Potera, C. (2016). Violence against nurses in the workplace. AJN, American Journal of Nursing: June 2016 - Volume 116 - Issue 6 - pp 20-21. Rogers, E. (16 August 2003). “Diffusion of Innovations, 5th Edition.” New York: Simon and Schuster. U.S Bureau of Labor statistics, BLS. Nonfatal Occupational Injuries and Illnesses by Industry. Retrieved From https://www.bls.gov/iif/oshsum1.htm 23 NURSING 24 Appendix 1 Results Summary N=58 Knowledge of the EBP Program. Application of the EBP Programs Hindrance to EBP Programs • Insufficient Time • Lack of Staff • Lack of Equipment • Lack of Interest • Lack of knowledge • Lack of adequate systems Reasons to adopt EBP Programs • Interests for change in clinical practice • It is valuable • Improving clinical care • It supports nurses and caregivers • Requirement by Health Regulators • To protect patients Percentage Score (%) 64 34.5 Valid Yes Yes Yes 38 42 38 12 36 48 Yes 44 68 52.3 76 58 52 Invalid NURSING 25 Appendix 2 Budget plan. Task Personnel (Trainers) Number 10 Actor State Health department ANA members Health facility Cost $5000 Alterative trainees Equipment Based on the need $1000 25 Health facility $30,000 1 IT specialists $5,000 Use facilities available resources Based on facilities-some have computers. Improvement of existing systems or new implementations Computer Database development Conference costs 200 (Accommodation and Meals) Transportation 3 (Vehicle) Health staff Trainers $30,000 Trainers $3,000 per day for 2 months Stationery needed Trainers $5000 Health facility car fueled by the program. Based on the need of the training program. NURSING 26 Work plan Action Creating awareness of workplace violence Identification of health centers with violence cases and development of a work plan. Training of workers on ways to deal with workplace violence and reduce the risks. Implementation of Database for violence management and training of workers Monitoring and evaluating the program. Actor Health Director Heads of Nursing Association Research team Time taken 2 week Research team 2 months A team from the Nursing Association Research team 2 month Health facilities IT team Research team Health facilities IT team Head nurses in health facilities 2 week 1 month Expected outcome Knowledge of the issue Desire to take action Decision to implement the program Planning on the implementation plan Application of lessons Reduced workplace violence cases Computerized system for record keeping Data collection on performance and violence trends Assessment of data collected from sample population
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