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Evidence-Based Practice Survey Summary
Christina Graham
Grand Canyon University
Evidence-Based Practice Project
NUR – 699
June 17th 2017
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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.
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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
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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.
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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
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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
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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.
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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
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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.
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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
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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.
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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.
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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.
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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
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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.
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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
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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
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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
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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
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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.
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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). More than half of emergency department nurses
have been physically assaulted at work, new study finds. Retrieved from
http://www.ena.org/ MEDIA/PRESSRELEASES/Pages/ WorkPlaceViolence.aspx
Fernandes, C.M., Bouthillette, F., & Raboud. J.M, (November 1999). "Violence in the
emergency department: a survey of health care workers". Canadian Medical Association
Journal, 161 (10): 1245–8.
Gacki-S. J., Juarez. A. M., Boyett. L., Homeyer. C., Robinson. L., & MacLean S. L. (2009).
Violence against nurses working in US emergency departments. Journal of Nursing. JulAug; 39(7–8):340–9. DOI:http://dx.doi.org/10.1097/NNA.0b013e3181ae97db
Gates, D., Gillespie, G., Smith, C., Rhode, J., Kowalenko, T., & Smith, B. (2011). Using action
research to plan a violence prevention program for emergency departments. Journal of
Emergency Nursing, 37 (1), 32-39.
NURSING
22
Hack, L., & Gwyer, J. (2013). Evidence into Practice: Integrating Judgment, Values, and
Research. Philadelphia, PA: F.A. Davis Co.Publishers.
Jordana, J. (2011). The Global Diffusion of Regulatory Agencies: Channels of Transfer and
Stages of Diffusion. Comparative Political Studies, 44 (10): 1343–1369.
Marsh, D.; & Sharman, C. (2009). Policy Diffusion and Policy Transfer. Policy Studies, 30 (3);
269–288.
Melnyk, B. M.; Fineout-Overholt, E.; Gallagher-Ford, L.; & Kaplan, L. (2012). “The state of
evidence-based practice in US nurses: critical implications for nurse leaders and
educators.” Journal of Nursing Adminisration. 42 (9):410–417.
Meyer, G. (2004). "Diffusion Methodology: Time to Innovate?” Journal of Health
Communication: International Perspectives, 9 (S1): 61.
Moja, L.; Kwag, H.; Bertizzolo, L.; Lytras, T.; Brandt, L.; Rigon, G.; Pecoraro, V.; Vaona, A.;
Mangia, M.; Ruggiero, F.; Iorio, A.; Bonovas, S,; Kunnamo, I. (December 2014).
"Effectiveness of computerized decision support systems linked to electronic health
records: a systematic review and meta-analysis". American Journal of Public Health.
104 (12): e12–22.
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
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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
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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.
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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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