Sufficient Staff Training for Prevention and Management of Violence - Research Proposal Example

? Research Proposal- Sufficient Staff Training for Prevention and Management of Violence in Acute Inpatient Psychiatric and mental health care Units Katherine Mooney January 29, 2012 Abstract The research proposal seeks to explore how far staff training contributes to the prevention and management of violence in acute inpatient psychiatric and mental health care units. The research would make use of both qualitative and quantitative research approaches. The study will focus on a sample group of health care professionals who work in psychiatric and mental health care hospitals in Alabama and Florida. A preliminary mailed questionnaire will be used to eliminate all those who do not meet the inclusion criteria. A telephonic interview will be administered on these respondents to know their willingness to attend the one-week staff training program. A before and after study design will be employed and the selected participants will be offered a one week staff training. The conclusions of the study will be drawn by a) analyzing the responses of the participants regarding their prior experiences of violence b) analyzing their prior knowledge regarding de-escalation techniques, risk assessment tools, and training in Nonviolent Crisis Intervention; c) analyzing staff responses after the one week training; d) analyzing the responses of the participants regarding their experiences of violence after the training; e) comparing and contrasting research outcomes of ‘a’ & ‘d’ and f) comparing and contrasting research outcomes of ‘b’ & ‘c.’ The research outcomes of this study will be useful not only to the health care professionals in these states but also to the whole of the health care industry in the United States. Statement and Significance of the Problem Over the years, researchers have stressed on the relationship between caregivers and clients. Special consideration to this relationship is given in terms of behavioral health sciences because of the increased potential for aggression with this client population. Mental health caregivers can considerably reduce the number of violent incidents that are more likely to happen in an acute inpatient psychiatric unit (Glick, Berlin, & Fishkind, 2008). Studies have revealed that healthcare workers including nurses, physicians, psychologists and social workers are likely to experience physical assault or verbal violence from patients in behavioral health units. The amount of violence has increased in various workplaces and researchers such as Rippon have identified exposure to violence as a significant problem for health care professional as well (Rippon, 2000). The need to offer timely staff training programs to the healthcare professions for the prevention and management of violence has been pointed out by such researchers as Doughty (2005); Warshaw & Messite (1996); and Flannery et al (2000). Similarly, the adverse effects and negative consequences of patient violence on the health care workers have also been pointed out by such researchers as Doughty (2005) and Stathopoulou (2003). The before and after studies conducted by researchers such as Calabro, Mackey and Williams (2002) have also revealed that staff training enhances the knowledge, attitude, self-efficacy, and behavioral intention of the participants towards violence in the work place. Training staff servicing in psychiatric and mental health care units are more likely to experience incidents of violence and therefore it is imperative that further researches are undertaken in this regard to identify how far staff training helps in preventing violence in acute health care units. The main objective of this research is to evaluate the correlation of trained staff working in acute inpatient psychiatric units and the number of violent incidents observed within the milieu. The research aims to give prominence to the need of training which is required to prevent and manage the incidents of violent episodes. This research will be helpful for the population in the medical field including nurses, doctors, social workers and therapists, and will attribute to their understanding of violence prevention and management. It has been noted that there has been a negligible amount of attention given to the need of research for training staff servicing in psychiatric units. Consequently, an increase in the number of cases for physical aggression has been noted. For this reason, research will be conducted in the context of relationships between staff and clients with a mental health diagnosis. This research is appropriate in terms of developing a background as to why training for prevention and management of violent events is necessary. Literature Review There are a large number of studies that focus on the physical assault or verbal violence shown towards healthcare workers including nurses, physicians, psychologists and social workers. There are also studies that have highlighted the need to offer staff in-service training to the health care professionals. The literature review of this paper will focus on those studies that establish a relationship between such staff training and the management or prevention of violence in psychiatric and mental health care units. Researchers also observe that the amount of violence has increased in various workplaces and researchers such as Rippon have identified exposure to violence as a significant problem for health care professional as well (Rippon, 2000). As such the literature review would focus on the nature and type of violence experienced by health care staffs in inpatient psychiatric units. The review of literature also seeks to explore research studies that have tested the outcomes of various staff training programs, in-service trainings and intervention programs aimed at managing and preventing violence in behavioral health units. The insights gained from the literature review will form the starting point for this research. The literature review will elaborately deal with Doughty’s research article on staff training programs and the prevention and management of violence in mental health services and emergency departments as the author indulges in a thorough meta-analysis of the previous studies on the issue. Doughty (2005) has undertaken some remarkable studies on staff training programs for the prevention and management of violence. The author observes that staffs in behavioral health units need to be taught about the “risk factors that cause or contribute to assaults, ways to prevent, diffuse or de-escalate volatile situations or aggressive behavior, ways of developing and implementing workplace violence prevention policies and teaching staff procedures and policies for reporting and recording incidents” (Doughty, 2005, p. 1). The adverse effects of patient violence on the health care workers are many and varied. In this respect, Doughty, reviewing a large number of literature, points out that the aftermath of the experience of violence include post-traumatic stress disorders, subsequent loss of confidence and self esteem, subsequent increases in sick leave and alcohol and drug usage and cab adversely affect staff recruiting and retention within the organization (Doughty, 2005, p. 1). Specially trained nurses and heath care professionals in risk assessment and management of violence will be better equipped to respond to violence in their workplaces than their counterparts. There have been many staff programs that have been proved to be extremely beneficial for the health care industry in managing violence. For instance, the Assaulted Staff Action Program (ASAP), a voluntary program introduced by the United States has been proved beneficial for the healthcare staffs. All these call for the need to identify how effective are staff training programs in preventing and managing violence among nurses and other behavioral healthcare workers. Thus, Doughty’s research article will form one of the key sources for the proposed research. The literature review will also try to review other authentic studies as well. The research findings of Warshaw and Messite (1996) will be useful for the current study as the researchers have pointed out that effective and timely intervention strategies are essential to uplift the health care professionals who have fallen as victims of patient violence and assault. These intervention strategies may include stress management, rehabilitation of staff victims and providing them a work environment that is not conducive to violent behavior (Warshaw & Messite, 1996). The research article will also help the researcher to identify some of the potential variables of the study as well. The studies conducted by Stathopoulou (2003) will be useful for the proposed research as the research article deals elaborately with the negative consequences of violence on health care professionals and provides useful guidelines to the health care professionals as to how they can effectively interact with the patients’ families. The author is of the opinion that the preventive measures on violence towards health care professionals should focus on three areas: hospital organization, arrangement of the physical environment, and staff training and development (2003, p. 4). The research article will be highly useful in identifying such staff training and development programs that would focus on the existing medical, psychiatric and social conditions, ‘effective use of communication skills and de-escalation techniques,’ ‘techniques for crisis intervention and conflict resolution,’ ‘reporting and documentation of all violent events,’ and ‘application of physical restraints’(Stathopoulou, 2003, p. 4). The literature review will also make use of the studies conducted by Flannery et al. (2000) on the effectiveness of Assaulted Staff Action Program (ASAP) among the staff who work in mental health services whereby the researchers came to the conclusion that ASAP is a competent intervention for reducing the frequency of assaultive behavior towards health care professionals. Researchers such as Calabro, Mackey & Williams (2002) have conducted a remarkable before-and-after study design among 180 hospital staff in an acute care psychiatric hospital and their research outcomes will also be included in the literature review. The researchers offered all staffs one and a half day training in preventing and managing patient violence. The training classes focused on two intervention programs-Nonviolent Crisis Intervention (CPI) and Handle with Care program. While CPI aimed at training staff how to prevent and control disruptive behavior of clients the Handle with Care program equipped the staffs with the necessary self-defense skills and restraining methods to tackle potentially violent patients. The authors resorted to a pretest and posttest study design and the results of the study proved that the training had positive outcomes on the knowledge, attitude, self-efficacy, and behavioral intention of the participants towards violence in the work place. Thus, the studies conducted by these researchers will be analyzed in the literature review of the proposed research. The literature review will also review the research article of Arnetz and Arnetz (2000) as it depicts the outcomes of a randomized controlled trial among healthcare professionals in psychiatric and emergency departments. The researchers have claimed that staff training and timely interventions have enhanced staff knowledge of risks for violence among the participants. It is also worthwhile to review the before and after study of Cowin et al. (2003) as the authors elaborately deal with the benefits of teaching health care professionals the necessary de-escalation techniques and in-service training that would enhance their knowledge and better equip them to face incidents of violence in the psychiatric and mental health settings. The literature review will also deal with the research outcomes of the INTACT Aggression Management Program, the two-day intensive training program administered by Ilkiw-Lavalle et al. (2002) among a group of 103 mental health staffs in Australia as this would offer fresh insights to the present study. The before and after study employed by Martin (1995) also deserves special attention in this regard as the author deals with the research outcomes of having administered Aggression Management Workshop and a video on verbal de-escalation techniques among staffs who work in psychiatric units. The literature review will also take into account the theoretical insights of authentic books on staff training and management of violence in acute health care units. Management of Violent Behavior: Collected Articles from Hospital and Community Psychiatry published by American Psychiatric Association (1988) is a seminal book that deals with the various aspects of staff training in managing violence in the healthcare industry and the literature review will make use of this book as well. Workplace violence in mental and general healthcare settings by Michael R. Privitera (2011) will be another useful book for the proposed research. Sheilagh (2000) also offers useful guidelines in understanding and assessing the risk factors associated with offering health care services to patients in psychiatric units. The theoretical contributions of these authors will be reviewed in the literature review part of the current research. A review of the literature clearly demonstrate that most of the previous studies on staff training and prevention and management of violence in health care units were before and after studies that focused on the performance of the health care professional before and after the training had been offered to them. However, most of these studies have failed to pinpoint noticeable changes among the participants. The other study designs employed by the researchers consisted of randomized controlled trials on a target group or comparative studies among two or more groups of health care professionals. The intervention and strategies of these staff training programs consisted of training in recording and monitoring incidents, training in the use of a risk assessment tools, training in Nonviolent Crisis Intervention (NVI), interactive staff training in de-escalation techniques, and aggression management workshops. In light of the studies reviewed, there is a need to conduct further study that clearly pinpoint how far staff training contributes to managing and preventing violence in acute inpatient psychiatric units. Reviewing the literature it is clear that a qualitative as well as quantitative research design will be more useful for the present study. Similarly, a before and after study on a sample target group (who will be screened based on the amount of violent experiences they` had in the past via carefully designed mailed questionnaire) will be employed for the current study. Research Question OR Hypothesis The research hypotheses for this research are: 1) health care professionals in acute inpatient psychiatric units are exposed to patient violence; and 2) there are limited evidences from previous studies that effective staff training is capable of preventing or managing violence in such health care settings. Therefore, the research question for this study is “how far staff training contributes to the prevention and management of violence in acute inpatient psychiatric units in Alabama and Florida?” (For a list of the major inpatient psychiatric units in these states see Appendix 1). These states are selected for the study as they are neighboring states that consist of a considerable number of established acute inpatient psychiatric units. The key variables for the study are: 1) incidents of patient violence before and after the training (dependant variable), 2) evaluation of staff responses before and after the training in terms of staff knowledge, staff attitude, de-escalation techniques, risk assessment tools, and training in Nonviolent Crisis Intervention. The term health care professionals in acute inpatient psychiatric units may include nurses, doctors, psychiatrists, psychologists, marriage and family counselors, professional clinical counselors, and mental health professionals who work among patients with behavioral problems or disorders. Similarly, the term violence includes both physical and psychological or mental violence. Methodology Study Setting The study will focus on a sample target group (who will be screened based on the amount of violent experiences they` had in the past via carefully designed mailed questionnaire) of health care professionals who work in psychiatric and mental health care hospitals in Alabama and Florida. A preliminary mailed questionnaire will be used to eliminate health care professionals with no prior experiences of violent behavior. Research Design The research will make use of a qualitative as well as quantitative approach to ensure complete understanding of the cases of violence reported previously. Primary sources will allow for evaluation of the benefits of training offered to behavioral health staff. Secondary sources will offer an objective view of research by in-depth published literature (Hillard, Hillard, & Zitek, 2003).While quantitative research designs will be employed to measure incidents of patient violence before and after the training qualitative research designs will be employed to evaluate the staff responses. A before and after research design will be employed to obtain both qualitative and quantitative data. Sample and Sampling Procedure The research will target a sample population of health care professionals who work in acute inpatient psychiatric units in the three states of Alabama, Mississippi and Florida. A list of all the staffs who work in these states will be obtained and a preliminary mailed questionnaire will be sent to them. The questionnaire would elicit such details as their designation, age, gender, years of experience, receipt of any prior staff training, incidents of violent experiences etc. The respondents who do not have any prior experiences of patient violence will be eliminated from the study. Similarly, all those respondents who do not have at last three years of experience will also be eliminated. However, respondents of all ages will be included in the study sampling. A telephonic interview will also be administered on these respondents to tell them of the nature of present research and to know their willingness to attend the one-week staff training program. The unwilling respondents will also be eliminated. Data Collection A preliminary mailed questionnaire will be used to eliminate all those who do not meet the inclusion criteria mentioned in the previous section. A telephonic interview will be administered on these respondents to know their willingness to attend the one-week staff training program. During the first phase, the responses of the participants regarding their prior experiences of violence (which include the frequency, type and nature of violence) and knowledge regarding de-escalation techniques, risk assessment tools, and training in Nonviolent Crisis Intervention will be recorded. After the one-week staff training program staff responses regarding their awareness of knowledge, attitude, de-escalation techniques, risk assessment tools, and training in Nonviolent Crisis Intervention will also be evaluated. After six months of the staff training program another mailed questionnaire (which will include both closed and open ended questions) will be sent to each respondents to collect further incidents of violence in the workplace. A comparative analysis of the variables received before and after the one week staff training program would yield the research outcomes of the study. Data Analysis The data analysis for this paper consists of a) analyzing the responses of the participants regarding their prior experiences of violence b) analyzing their prior knowledge regarding de-escalation techniques, risk assessment tools, and training in Nonviolent Crisis Intervention; c) analyzing staff responses after the one week training; d) analyzing the responses of the participants regarding their experiences of violence after the training; e) comparing and contrasting research outcomes of ‘a’ & ‘d’ and f) comparing and contrasting research outcomes of ‘b’ & ‘c.’ Frequency distributions and descriptive statistics will be used to analyze these data. Factor analysis and regression techniques can also be employed. Strengths and Weaknesses The current research could be the first one that undertakes such a study on the relationship between staff training and the management or prevention of violence in acute inpatient psychiatric units in Alabama and Florida. The research outcomes of this study will be extremely useful to the whole health care professionals in these states. Similarly, the current study distinguishes itself from many before and after studies that only evaluated only the differences in staff knowledge and attitudes. However, the study has got its own limitations too. As the study covers a wide area of three states it is not possible for the researcher to have a one to one interaction with all the participants. Similarly, it will be practically difficult for the researcher to arrange a one week staff training program to the currently working health care professionals. It can also be noticed that the study draws its conclusions from two mailed questionnaires and the completion of the research would take at least one year of duration. However, the study will bring about certain useful research outcomes that would be beneficial to the health care industry of the whole nation. References American Psychiatric Association. (1988). Management of Violent Behavior: Collected Articles from Hospital and Community Psychiatry. American Psychiatric Pub. Arnetz, J. E., & Arnetz, B. B. (2000). Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers. Journal of Advanced Nursing, 31, 668-680. Calabro, K., Mackey, T. A., & Williams, S. (2002). Evaluation of training designed to prevent and manage patient violence. Issues in Mental Health Nursing, 23, 3-15. Cowin, L., Davies, R., Estall, G., Berlin, T., Fitzgerald, M., & Hoot, S. (2003). De-escalating aggression and violence in the mental health setting. International Journal of Mental Health Nursing, 12, 64-73. Doughty, C. J. (2005). Staff training programmes for the prevention and management of violence directed at nurses and other healthcare workers in mental health services and emergency departments. NZHTA Technical Brief, 4(2), 1-59. Retrieved 22 February 2012, from: http://www.otago.ac.nz/christchurch/otago014021.pdf Flannery, R. B., Jr., Anderson, E., Marks, L., & Uzoma, L. L. (2000). The Assaulted Staff Action Program (ASAP) and declines in rates of assault: mixed replicated findings. Psychiatric Quarterly, 71, 165-175. Glick, R., Berlin, J., & Fishkind, A. (2008). Emergency psychiatry: principles and practice. New York: Lippincott Williams & Wilkins. Hillard, R., Hillard, J., & Zitek, B. (2003). Emergency psychiatry. Chicago: McGraw-Hill. Hodgins, Sheilagh. (2000). Violence among the mentally ill: effective treatments and management strategies. Illustrated ed: Springer. Ilkiw-Lavalle, O., Grenyer, B. F. S., & Graham, L. (2002). Does prior training and staff occupation influence knowledge acquisition from an aggression management training program? International Journal of Mental Health Nursing, 11, 233-239. Martin, K. H. (1995). Improving staff safety through an aggression management program. Archives of Psychiatric Nursing, 9, 211-215. Privitera, Michael R. (2011). Workplace violence in mental and general healthcare settings. London: Jones & Bartlett Publishers. Rippon T.J. (2000). Aggression and violence in healthcare professions. Journal of Advanced Nursing, 31 (2), 452-460. Stathopoulou, H.G. (2003). Violence and Aggression towards Health Care Professionals. Health Science Journal, 1(2), 1-7. Retrieved 22 February 2012, from: http://www.hsj.gr/volume1/issue2/issue02_rev03.pdf Warshaw L.J. & Messite J. (1996), Workplace violence: preventive and interventive strategies. Journal of Occupational and Environmental Medicine, 38, 993-1006. Appendices Appendix 1: The List of Psychiatric and Mental Health care Hospitals in Alabama and Florida. Alabama North Alabama Regional Hospital - Decatur, Morgan County, Alabama Searcy Hospital - Mount Vernon, Mobile County, Alabama Taylor Hardin Secure Medical Facility - Tuscaloosa, Tuscaloosa County, Alabama Bryce Hospital - Tuscaloosa, Tuscaloosa County, Alabama Greil Memorial Psychiatric Hospital - Montgomery, Montgomery County, Alabama Hill Crest Behavioral Health Services - Birmingham, Jefferson County, Alabama Laurel Oaks Behavioral Health Center - Dothan, Houston County, Alabama Mary Starke Harper Geriatric Psychiatry Center - Tuscaloosa, Tuscaloosa County, Alabama Mobile Mental Health Center - Mobile, Mobile County, Alabama Mountain View Hospital - Gadsden, Etowah County, Alabama North Alabama Regional Hospital - Decatur, Morgan County, Alabama Psychiatric Solutions, Inc. Hill Crest Behavioral Health Services - Birmingham, Jefferson County, Alabama Laurel Oaks Behavioral Health Center - Dothan, Houston County, Alabama Searcy Hospital - Mount Vernon, Mobile County, Alabama Taylor Hardin Secure Medical Facility - Tuscaloosa, Tuscaloosa County, Alabama University of Alabama at Birmingham (UAB) Center for Psychiatric Medicine - Birmingham, Jefferson County, Alabama Florida 45th Street Mental Health Center - West Palm Beach, Palm Beach County, Florida Atlantic Shores Hospital - Fort Lauderdale, Florida Citrus Health Network, Inc - Inpatient and outpatient behavioral health services. Hialeah and Miami, Florida. Devereux Florida - Orlando, Orange County, Florida Eastside Psychiatric Hospital - Tallahassee, Florida Florida Department of Children & Families Florida State Hospital - Chattahoochee, Gadsden County, Florida North Florida Evaluation & Treatment Center - Gainesville, Alachua County, Florida Northeast Florida State Hospital - Macclenny, Baker County, Florida South Florida Evaluation & Treatment Center - Pembroke Pines, Broward County, Florida Treasure Coast Forensic Treatment Center - Indiantown, Martin County, Florida Florida State Hospital - Chattahoochee, Gadsden County, Florida Fort Lauderdale Hospital - Fort Lauderdale, Florida Gulf Coast Treatment Center - Fort Walton Beach, Florida Hollywood Pavilion - Hollywood, Florida La Amistad Behavioral Health Services Psychiatric hospital - Maitland, Florida Lakeview Center - Pensacola, Escambia County, Florida LifeStream Behavioral Center - Leesburg, Florida Manatee Glens Hospital - Bradenton, Manatee County, Florida Manatee Palms Youth Services - Bradenton, Manatee County, Florida National Deaf Academy - Mount Dora, Lake County, Florida New Horizons of The Treasure Coast - Psychiatric treatment center. Fort Pierce, Saint Lucie County, Florida North Florida Evaluation & Treatment Center - Gainesville, Alachua County, Florida Northeast Florida State Hospital - Macclenny, Baker County, Florida Port Saint Lucie Hospital - Port Saint Lucie, Saint Lucie County, Florida Psychiatric Solutions, Inc. Atlantic Shores Hospital - Fort Lauderdale, Florida Fort Lauderdale Hospital - Fort Lauderdale, Florida Gulf Coast Treatment Center - Fort Walton Beach, Florida Manatee Palms Youth Services - Bradenton, Manatee County, Florida National Deaf Academy - Mount Dora, Florida Sandy Pines Hospital - Tequesta, Florida University Behavioral Center - Orlando, Orange County, Florida Windmoor Healthcare - Clearwater, Florida Ruth Cooper Center for Behavioral Health Care - Fort Myers, Florida Sandy Pines Hospital - Tequesta, Florida Shands Vista Behavioral Health - Gainesville, Alachua County, Florida South Florida Evaluation & Treatment Center - Pembroke Pines, Broward County, Florida Southern Winds Hospital - Hialeah, Florida Springbrook Hospital - Brooksville, Florida Ten Broeck Hospital Jacksonville - Jacksonville, Duval County, Florida Treasure Coast Forensic Treatment Center - Indiantown, Martin County, Florida University Behavioral Center - Orlando, Orange County, Florida Willough Healthcare System - Naples, Collier County, Florida Windmoor Healthcare - Clearwater, Florida Source: Psychiatric Hospitals & Medical Centers. (2011). Retrieved 26 February 2012, from: http://www.theagapecenter.com/Hospitals/Psychiatric.htm Read More