Reducing Violence in the Emergency Department.

Running head: EVIDENCE BASED PRACTICE 1

 

 

 

 

 

 

 

 

Evidence Based Practice Project Proposal

Student Name

NURS 3555

Columbus State University

 

 

 

 

 

 

 

 

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EVIDENCE BASED PRACTICE

 

CAPSTONE PROJECT PROPOSAL

Project Title

Reducing Violence in the Emergency Department.

Project Description

The goal of this project is not only to bring awareness to nurse directed violence in the

Emergency Department (ED), but also to introduce new education materials and staff training in

an attempt to prevent violent acts from occurring. This project describes and analyses three

different nursing articles which include research on methods utilized in a clinical setting to

prevent violence brought on by patients towards healthcare professionals. Research and data

from these articles will be utilized in an effort to prevent ED violence by taking methods that

have been proven to decrease violence and implementing them locally. Local ED staff and

administration will be educated on prevention methods and techniques taken from researched

based evidence in hopes of creating a violence prevention protocol to protect nurses and other

healthcare workers.

Project Rationale

This project topic was selected based on the need for increased awareness and

intervention to prevent the frequency of violent acts towards healthcare staff in the ED.

Caregivers must be protected. Nurses must advocate for themselves, for one cannot provide

proper care for multiple patients when being threatened or attacked. While patient violence can

happen anywhere, research shows that it occurs more often in Emergency Departments than in

many other clinical settings (Gillespie, Gates, Kowalenko, Bresler & Succop, 2014). Currently,

there is little research and few recommendations available for a plan or protocol that will

significantly reduce patient violence. Many hospitals across the nation offer a one-time

 

 

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educational class on crisis prevention training; however, this has proven to not be adequately

effective due to the frequent incidents of patient violence that still take place. The research

articles examined in this project will be used to cultivate a violence prevention protocol.

Nurses and other healthcare workers will receive immediate benefit from this project as

the occurrence of violence decreases. They are the major take holders in this project. This is

obviously beneficial for the safety of staff and will help decrease burn out. Patients will also

benefit from not acting out in violence, as care is sure to be better when the caregivers do not feel

scared, threatened, or attacked. Care is certain to be provided in a more timely matter, as dealing

with the aftermath of a violent attack is time consuming and takes away from other patients.

Hospitals and administration also benefit from the implementation of a violence prevention

protocol, as it is cost-effective in that it prevents financial and legal issues from staff related to

patient attacks. Violence prevention is not only imperative for ED staff but also patients.

Personal/Professional Expectations

As an ED nurse, this project topic is very personal for me. My personal and professional

expectations for this project are the same. Through this project, I hope to bring awareness of the

high prevalence of ED violence and the need for action to my peers and co-workers. I also hope

to bring about a violence prevention protocol at my workplace based upon successful evidence

and nursing articles. I ultimately hope that a violence prevention program will be successfully

implemented in every ED across the nation.

Project Goals

As previously stated, I hope to bring increased awareness and prevention tactics to ED

violence. I hope my co-workers will become fully educated on the need for change and support

the implementation of patient violence prevention protocols in the ED where I work. This

 

 

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project will explore the need for violence prevention programs in EDs, and will examine

research from scholarly nursing articles that describe staff education methods and de-escalation

team organization and tactics. Methods proven in these studies to be successful will be used as a

part of my plan for violence prevention. For instance, a specialized team would be beneficial in

preventing violence as the team would be called upon to respond to agitated patients, this team

would use therapeutic communication to de-escalate or calm the patient before violence took

place (Kelley, 2014). Thorough education on violence prevention with regular educational

updates would also help this cause. A decrease in violent acts will be achieved by thoroughly

educating hospital staff and administration of the risks of frequent patient violence and the

benefits that the hospital, staff and patients will receive by implementing policies regarding

violence prevention.

PICO(T) Question

How do methods such as extended education on violence prevention and use of a de-

escalation team reduce patient violence toward healthcare workers compared to the current

limited prevention measures?

Research

Each research article used in this project is a Level V quasi-experimental study. The first

article discusses how the highly prevalent use of restraints significantly decreased after the

implementation of a specially trained de-escalation team, which provided early therapeutic

intervention to agitated patients before the eruption of violence (Kelley, 2014). The second

article describes the change and violence reduction that occurred after the implementation of new

policies and staff education in three different EDs (Gillepsie, Gates, Kowalenko, Bresler &

Succop, 2014). The third article explores how both online and in classroom education increases

 

 

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ED staffs knowledge related to the prevention of patient violence (Gillespie, Farra & Gates,

2014). This project analyzes each research study and will use evidence-based prevention

methods to prevent ED violence locally.

Procedure

Resources needed for change to occur at the local level will include this project, and

evidenced based recommendations from scholarly research articles. Several research articles on

this topic can be found online through Galileo. Local ED staff and nursing management will first

need to be educated on the importance and benefits of change. Then, progressing up the chain of

command, department heads and hospital administration will need to be educated on the same

benefits. Staff and administration education may take up to two weeks. Then, administration and

nursing management must come together to approve and finalize evidenced based policies on

violence prevention, including increased staff education and implementation of a de-escalation

team. This process may take three to four weeks. Organization and implementation of proper

educated materials and new policies may take one to four months.

Recommendations

Change at the local level may be accomplished by basing policies and education on

successful methods utilized in nursing research studies. Any major change must be approved by

ED managers and hospital administration. With proper approval, change can be accomplished

with extensive staff education. This does not mean a simple one hour class on violence

prevention, but rather an educational series that includes periodic testing on specific violence

prevention and patient de-escalation methods with regular updates and follow up in education

(Gillespie, Farra, & Gates, 2014). The development and implementation of a specially trained

de-escalation team would highly benefit local EDs and drastically reduce the number of violent

 

 

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acts that currently take place. This team would be made of up several different members of the

healthcare team, including nurses, clinical technicians and social workers. This team would will

available by page overhead and would respond to aggressive or agitated patients in an attempt to

calm them down before violence or extreme measures such as chemical or physical restraints

were needed (Kelley, 2014).

Evaluations

Evaluation of the success of this project would be based on the decrease in the number of

healthcare worker directed violent acts occurring in the ED where interventions were

implemented. For proper evaluation, data regarding the previous number of violent attacks from

ED patients would need to be analyzed and compared to the number of violent attacks from

patients following the implementation of prevention policies. Data may also be gathered

regarding how often the de-escalation team was called to respond to an agitated patient. The

success of this team may be evaluated by examining the percentage of patient violence occurring

with or after the use of the de-escalation team. The success of appropriate staff education may be

judged staffs tests scores, with expected increased scores on each sequential test. Evaluation of

this project is imperative for determining the success of the project and change. If in the

evaluation process it is determined that this has not been successful, it is back to drawing board

because patient violence in EDs must be prevented; therefore, new research, planning and

interventions would begin again.

 

 

 

 

 

 

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References

Gillespie, G. L., Farra, S. L., & Gates, D. M. (2014). A workplace violence educational

program: A repeated measures study. Nurse Education In Practice, 14468-472.

doi:10.1016/j.nepr.2014.04.003

Gillespie, G. L., Gates, D. M., Kowalenko, T., Bresler, S., & Succop, P. (2014).

Implementation of a comprehensive intervention to reduce physical assaults and threats

in the emergency department. Journal Of Emergency Nursing: JEN: Official Publication

Of The Emergency Department Nurses Association, 40(6), 586-591.

doi:10.1016/j.jen.2014.01.003

Kelley, E. C. (2014). Clinical: Reducing Violence in the Emergency Department: A Rapid

Response Team Approach. Journal Of Emergency Nursing, 4060-64.

doi:10.1016/j.jen.2012.08.008