monitor or to identify the incidences of violence in the workplace

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Workplace Violence Prevention Program to Reduce Violence in Emergency Department and improve Safety of Employees

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Date: 09/12/18


Workplace Violence

“Workplace violence is the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty. The impact of workplace violence can range from psychological issues to physical injury, or even death” (NIOSH,2016).

Problem Description

Workplace violence (WPV) is a weighty problem in all health care settings.

Emergency room nurses and employees experience physical and verbal assaults from patients and visitors in a higher rate.

According to the Emergency Department (ED) Violence Surveillance Study conducted between 2009 and 2011 by Emergency Nurses Association, the overall frequency of physical and verbal assaults towards ED nurses was 54.5 percent during a one-week period (Emergency Nurses Association, 2011).

According to American Nurses Association’s Health Risk Appraisal survey, it is reported that 21 percent of registered nurses and nursing students being physically assaulted, and more than 50 percent were verbally abused in a 12-month period (OSHA, 2015). It is necessary to the organization to recognize and acknowledge the violence directed towards health care workers from patients and visitors. So that the institution can prepare staff to handle violence and address the impact more effectively (Sentinel Event Alert, 2018). The Joint Commission recommends to the healthcare organizations to define workplace violence and put systems into place across the organization that enable staff to report workplace violence instances, including verbal abuse.


PICOT Question

In an Emergency department, how does a workplace violence prevention program improve the safe work environment for nurses and other healthcare employees compared with the current practice?


Evidence From Literature

Study evidences provides the understanding of nationwide workplace violence (WPV) problem among the nurses and indicate the importance of developing a workplace violence prevention program (WPVPP).

Implementing a WPVPP helps effect change in the ED and hospitals in general by enhancing nurses’ perceptions of safety, and consequently ensuring that a healthy work environment based on trust respect, and safety is created in the ED (Martinez, 2016).

WPV increases stress level of ED nurses and it adversely affects the patient care (Gates, Gillespie & Succop, 2011). A cross sectional study conducted among Nurses from 100 hospitals in Taiwan found that 49.6 percent of nurses had an experience of at least one kind of violence at work and highest prevalence (55.5) was in Emergency department and Intensive Care Unit (Wei, Chiou, Chien, & Huang, 2016). A quasi experimental study to examine the effectiveness of comprehensive workplace violence program in reduction of violence lead to a conclusion that emergency rooms that had high rates of assaults and physical threats has a significant reduction of violence after implementing the WPVPP (Gillespie, Gillespie, G., Gates, Kowalenko, & ….Succop, 2014). Another study conducted among nurses, physicians and managers of 14 EDs shows that 76.1 percent among them experienced at least one kind of violence in a 12 month period (Hamdan & Hamra, 2015). WPV creates negative impacts not only on personal life of nurses but also produce negative effects on patient care and entire healthcare organization (Hassankhani, Parizad, Gacki-Smith, Rahmani, & Mohammadi, 2018).


Proposed Solution

A comprehensive Workplace violence Prevention Program (WPVPP) is the suggested intervention to prevent WPV in ED settings

Main focus will be on education and training nurses and other staff in ED on workplace safety as an intervention forming part of the WPVPP

The Training Program will focus on:

employee involvement in WPV prevention programs

Improving employee’s communication skills

De-escalation techniques

Accurate reporting of violent incidents

constructing healthcare workers-patient relationship

According to Kowalenko et al. (2012), a WPVPP is a policy-level intervention to violence in the ED which requires both commitment and support from the top leadership and management of a healthcare facility. The expected outcomes of the WPVPP project for the ED include improved and safe work environment for nurses and other healthcare employees in the ED and reduced incidents of violence inside the ED. The training of the ED nurses under this program will help to provide a safe environment for nurses by enabling them to identify potential causes of workplace violence and take appropriate measures to prevent them. It will also enhance safety through hazard assessment, de-escalation, and reporting of risks.


Workplace Violence Prevention Program

The building blocks for developing an effective workplace violence prevention program include:

Management commitment and employee participation

Worksite analysis

Hazard prevention and control

Safety and health training

Record keeping and program evaluation (OSHA, 2016).

Change Model to implement WPVPP in an Emergency room

Kurt Lewin’s change Theory which has 3 stages




Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) conceptual model

Kurt Lewin’s change theory is an approach that involves three stages. The stages include unfreezing, change and refreezing (Prochaska, 2008). Unfreezing process includes finding a technique for people to change their old behavior processes to that of new methods. In this stage, some of the barriers to implement the WVPP that include lack of accountability and commitment from the management team, varying perception of WPV, lack of action in spite of reporting and lack of incidence follow up need to be assessed and eliminated. Communication with different stakeholders such as administrators, managers, nurses, security personals and other ED staff is an important component in this stage to overcome the resistance to change. In the stage of change, people’s mindsets, behavior, and thoughts will be changed to bring a positive outcome. This is the stage of actual change that is planning, and implantation process carries out. ED nurses and other healthcare staff will be educated about how to assess the threats and de-escalate the violent behavior, how to manage the WPV and the importance of reporting the violence, and they will start to practice in their work setting.

Refreezing stage prevents the recurrence of previous conduct. It also considers the change in the new process is hence becoming the standard operating behavior. One way to institutionalize and sustain the new changes related to WVPP is workplace violence prevention policies and guidelines. The JHNEBP conceptual model will pilot the project through the use of evidence to promote positive outcomes (Lorch, 2007). The JHNEBP model helps to pilot the program and assists in dynamic notion from an unsafe to an anticipated safe environment.


Implementation Plan


Nurse Manager

ED Nurses

Clinical Educators

Emergency Room Technicians

ED security Officers

ED clerks

Time Line : 6 months

1st month: stakeholders buy in

2nd month: Resource selection

3rd Month: Team Creation

4th month: Training

5th month: Data collection

6th month: Data analysis

Study Setting: Emergency Department of Multispecialty Hospital

To enhance the implementation of the solution, the workplace violence policy statement is required; the policy refers to the clearly written statement that indicates the organizational top-level management commitment to the employee’s health and safety (Wei et al., 2016). Some other resources necessary for the implementation of the above program include the threat assessment team, hazard assessment team, medical records, insurance records, police reports, grievances, security records, training records and accident investigations (The Hartford Loss Control Department, 1999). After analyzing and reviewing the available records in ED setting, the research team may be able to identify the possible causes of violence, implement and recommend changes, and monitor the progress. Apart from carrying out the record review, the research team should also inspect the entire workplace as well as the tasks often performed to determine if the workers are at risk.


Implementation Plan

Method of Instrument : Questionnaires

To monitor or to identify the incidences of violence in the workplace, the use of a questionnaire is the best approach to obtain relevant information in order to facilitate the achievement of the proposed solution.

The questionnaires encourage the participation of employees when it comes to the designing and implementation of the program

While obtaining the information by using the questionnaire, the supervisors and managers are always responsible for maintaining and implementing the program. In the questionnaire, there are elaborate questions that attempt to acquire different information on the workplace violence and the possible solution. The questionnaire developed will be used to monitor the implementation of the proposed solution.


Implementation Plan

Data Collection Tools Include,


Workplace violence survey tool

Workplace security analysis tool

Workplace Violence Training Record

Threat assessment team will be responsible for Data collection.


Evaluation Plan

An evaluation plan is vital to determine effectiveness of the workplace violence prevention program.

Methods of Evaluation:


Direct interviews


The workplace violence data before 6 months and after 6 months of WPVPP implementation will be obtained to check if there is any reduction of violence.

Questionnaires are to be given to the ED staff to complete on their own by giving their views and opinions on the outcomes of the implemented plan. The ED staff will be asked questions face to face on the course of the implemented program to obtain their feedback. Observations are done through studying and recording any cases of violence to determine the viability of the implemented plan. The observation will involve behavior, attitudes, and appearances to determine the changes due to the program.



Workplace violence towards healthcare workers specially against nurses working in the emergency department is progressively becoming a severe and routine issue. In spite of cognitive effects on healthcare providers and patients in the ED such as injuries, anxiety, desertion of duty and minimized job gratification, this issue remains questionable and unsettled. Therefore, an evidence-based practice solution such as a workplace violence prevention program is necessary to help halt violence on staff in the Emergency department.


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