Evaluation of Staff Training Program on Nurses Especially in the Emergency Department - Literature review Example

Name : xxxxxxxxxxx Institution : xxxxxxxxxxx Title : Literature review for evaluation of Staff training program Tutor : xxxxxxxxxxx @2010 Table of Contents Table of Contents 2 Causes of violence in emergency rooms 2 Zero tolerance programs 3 Educational programs 4 The aggression management program 5 Behavior management program 6 Health surveillance programs 7 Post-incident strategies 7 Reporting and monitoring violence 8 OSHA (1996) program 9 CAL-OSHA (Injury and Illness Prevention (IIP)) Program 9 Post-assault Intervention 10 ASAP program 11 Collaboration between administrators and employees to set policies 11 Employee assistance programs 12 Total quality management or Organizational Intervention 13 Violence prevention program: Star program 14 Risk Assessment programs 14 Environment Modifications 14 Public awareness program 15 Conclusion 15 Bibliography 28 Literature review for evaluation of Staff training program Causes of violence in emergency rooms Both the Emergency Nurse Association and the American College for Emergency Physicians, cases of health care violence especially in the emergency department have been on the rise. The most common and predictable location for violence is in the emergency room. Care providers are often exposed to unpredictable patients and visitors with drug or alcohol impairment, or anguish from psychiatric disorders. The violence is normally caused by stress due to injuries, long durations of wait, and the prescription in the emergency rooms. This vibrant environment and its likelihood for violent disruption have emergency room workers, physicians, hospital management and security professionals (Bourgeois, 2004). Some of the staff training programs that have been employed to prevent the violence on nurses especially in the emergency department include: Zero tolerance programs Zero-tolerance program is a policy campaign addressing the issue of violence on the nurses and other medical staff in the emergency department from care recipients. This program has at the present been promoted by several governmental bodies as well as health care firms such as British Columbia Occupational Health and Safety Agency for Healthcare, New South Wales Department, International Council of Nurses of Health in Australia and the National Health services in Britain. By promoting the idea that violence or hostile behavior against members of staff in the emergency department is not acceptable, health care staffs are reassured that hostility and intimidation will no longer be condoned. This program has been employed in nursing homes and learning disability places. It can also be used mental health institutions although it is dependent on the condition of the patients in the centers (Beech, 2001). Zero-tolerance program is unique in that it focuses on sanctions against the initiators of violence which is not found in other violence prevention programs. The zero-tolerance program is launched with an aim of changing the opinions and attitudes of staff and management in regard to aggression and hostility by patients, clients and their families. The program is intended to inform the rights and respects of the health care staff and also informs the patients that violence against the medical staff is not allowed. The nurses in the emergency department are informed on the appropriate measures to balance both the needs of their patients and their own needs and not to put the patient’s needs first. In practice, the program informs the health care staff of their institutional policies where they experience violence (Beech, 2001). Educational programs Educating and training of frontline staff members in the most common program utilized in the prevention of violence against health care staff. This strategy to managing or decreasing violence is basically composed of educating staff on identifying any warning signs of aggressive behavior and the methods of averting, diffusing or resolving hostile conflicts through learning skills of behavior, aggression and control of conflicts. The program familiarizes the staff with institutional policies and strategies and their legal rights and responsibilities. The type of training offered must take into consideration the target high risk nurses who are regularly overlooked like the newly recruited and PSWs especially in the long-term care situations. In also includes training of the nurses on conflict resolution skills, early detection and mentoring skills. The programs needs to be directed towards particular types of resources and care recipients like those in the long-term medical care and cognitively impaired ones (Anderson, 2006). The aggression management program Most of these programs encompass the implementation of training procedures directed towards assisting health care staff to control violent or hostile behavior. Several of the training programs vary in philosophy, nature of curriculum and the manner in which the content material is delivered. An example of a Management of Aggression Training Program is one that begins on admission to the working staff and is then extended to a broad variety of community organizations and settings. The program starts with a theory element which entails the risk factors for violence, preventative approaches such as environmental factors, communication and calming techniques, medical contra-indicators before or in the course of physical intervention measures, law and physical strategies and post-incident support. This program also involves very important elements like the management of team, managing the environmental setup and controlling the patient in terms of aggression. A major constituent of this program is the sharing information and ventilating feelings which are core components of all workplace training programs. Such a component will include issues such as support, a chance for the staff in the emergency department to ventilate their opinions and feelings and sharing experiences concerning aggressive behavior. This program mainly controls violence that emanates from patients. It is also set to solve the problem of horizontal violence in the health care sector. Newly trained health care staffs in this program are consequently able to depersonalize horizontal hostility and confront its proponents thus participating in the resolution of the hostile behavior and enhance their learning experience (Rippon, 2000). Behavior management program A good example of a behavior management program is described by Burgio et al. the program involves a broad behavior management skills training schedule that emphasizes on enhancing effective non-verbal and verbal communication techniques like maintaining an appropriate eye contact, announcing individual activities and delaying physical assistance especially after a verbal prompt. It also entails reduction of ineffective communication skills such announcing several activities and utilization of multiple verbal prompts. The staff members participating in such a program are taught on the appropriate procedures of enhancing the application of effective antecedent and resulting behavioral techniques like distraction and diversion and minimize ineffective responses such as confrontations with residents. Elements such as videotaped illustrations of problem behaviors as well as documentations of vignettes can be addressed through the use of program workbooks. These types of programs are widely advocated and implemented in many institutions since they are generally comprehensive in regard to positive effects on position change and minimization of violence cases. There are though a few large scale and well designed case studies that can wholly provide evidence on the effectiveness of these programs. There is also some criticisms on the emphasizes of training in these programs since training puts pressure on the nurses in terms of reduction and control violence in institutions. This pressure should instead be placed on the organizations since they are responsible for effecting changes in management style as well as staffing. The type of training offered in the programs tends to charge the responsibility of controlling and managing of workplace aggression to the staff or the victims rather than the management of the institution. An incident of emergency department violence will be blamed on the staff’s failure to follow the strategies provided in the program which is not the case in most incidences (Allen & Tynan, 2000) Health surveillance programs These programs involve assessing the incident and factors that put nurses in the emergency department at a risk or threat to violence by their patients. Changes are then implemented based on the evaluation data of the factors that put the nurses at a risk. These programs have not however been very effective in the reduction of since data describing violence incidence in the emergency departments is not readily available. Nonfatal injuries inflicted on nurses have not been properly documented. The data collected however shows that various industries differ in terms of violence incidences experienced by their employees (Fitzpatrick & Norbeck, 1997). Post-incident strategies Although greater emphasize on prevention of emergency department violence is placed in pre-incident strategies, some emphasis is also accorded to post-incident strategies which intend to prevent future incidences for occurring. Organizations should invest adequate resources towards implementation of the post-incident strategies and programs. Some of the post-incident programs already in place include: Reporting and monitoring violence A better understanding of violence cases requires consistent monitoring of violent incidences through the establishment of preventive programs. An important instrument used in the programs is the Violent Incident Form (VIF), which is designed to record all the violent incidences that involve nurses in the emergency department. The VIF toll is a one-page document that entails verbal threats and aggression in its description of violence. The document is in form of a checklist that emphasizes on key aspects of a violent incident like time, place, culprit, event, and the resultant conditions. Another instrument used in this program is the Assault Log which offers the nurses in the health care centers a means of recording and describing physical assaults from patients. An effective reporting mechanism greatly assists in the reduction of violent behavior in the nursing department. An example of such a document was prepared by the multidisciplinary Behavioral Emergency committee so that workers involved in violence incidences could record their experience. When the form is effectively completed, it should give information in regard to location, type and intensity of every incident. It also seeks to encourage the medical staff in the emergency department to write a narration of the violence incidence and provide opinions in regard to prevention of such incidences in future (Barish, 2001). OSHA (1996) program This program stipulates the guidelines to undertake in the prevention of health care as well as other social workers against violence from patients. In some case, patients, relatives or other visitors carry weapons into health care institutions. The OSHA program recommends for searching strategies for weapons in psychiatric emergency rooms. This program has been effective since the searching policy resulted to discovery of weapons in jackets, purses and pockets which would otherwise have been used to cause injury. The program was also successful since more than 95% of the patients responded positively to the program while 93% of the nurse and 76% of the patients confirmed their support for the program and felt much safer in the medical organizations (Fitzpatrick & Norbeck, 1997). CAL-OSHA (Injury and Illness Prevention (IIP)) Program This program found in the California Code of Regulations consists of various elements which are aimed at preventing violence in the nursing department. The elements include responsibility, compliance, communication, hazard assessment and hazard correction. The program has been specifically designed for industries that Cal-OSHA classifies as non-high hazard (Eugene et al, 1993). Post-assault Intervention This is a program in which feedback discussions are held consistently through a structured post assault intervention measure. Staff members who have been directly involved in violence incidences are encouraged to participate in feedback discussions since their opinions and feelings of the incidence would give valuable information for the other health care staff. Additionally, the feedback discussions were viewed as informal debriefing sessions that provided useful information to assist and support nurses involved in violent incidences. The group discussions in regard to the incident emphasize on the major points included in the VIF checklist. These points include the perpetrator of the violent incidence, the cause of the incident, the time and place where the incident took place and the intensity of the incident. Other questions raised in the checklist is whether the victim detected in advance that the incident was likely to occur, how the situation was controlled and the response or reaction of the nurse affected. The fundamental hypothesis in the program is that medical staff at the intervention centers should report issues such as: better responsiveness of the threats of violence targeting the emergency department staff, an enhanced capability of handling threatening or hostile situations and minimum exposure to violent incidences than the expected level. Group debriefing, supervisory support and unofficial support from coworkers are effective approaches that have been incorporated in post-assault programs to assist in facilitating recovery from painful workplace incidences. These also assist in establishing a positive workplace environment in the care delivery system (Marin, 2004). ASAP program An example of an intervention approach that has been effective in the psychiatric inpatient and society settings is the Assaulted Staff Action Program (ASAP) the program is a voluntary initiative, peer-help approach for handling the psychological sequelae linked with patient assault. When an assault takes place, the ASAP team member on duty is summoned to the institutions where the incident has taken place and provides ASAP services to the affected nurses. A Critical Incident Stress Management (CISM) program by the Canadian health care system has been successful in facilitating the recovery of nurses affected by violence in the emergency department. The post-event responsibility of the CISM services also entails direct client services like evaluation, debriefing, defusing, and counseling services and follow ups. This includes referrals for Post Traumatic Stress Disorder evaluation and treatment. 92% of all the people that have used this program have reported that they can use the program once more while 81% reported the benefits hey go from the CISM services. 24% confessed that they would have quit their jobs had the services of CISM not intervened (Flannery, 1998). Collaboration between administrators and employees to set policies The nurses also have a significant role to play in the prevention of violence in emergency departments and virtually in all departments in medical institutions. The nurses should be involved in setting up policies that aim at preventing the violence against them since they are in the best positions to design the most appropriate strategies. This will ensure that proper allocation of resources ii terms of staffing, training and initiating proper controls. Although the role of nurse supervisors in the prevention of workplace violence has widely been overlooked, nurses can be very significant in designing organizational policies and programs to prevent violence in medical institutions. Employee assistance programs These programs involve debriefing and counseling of workers after incidences of violence and getting other services. These programs assist the nurses in prevention of similar programs in future should they take place. The programs involve training of the nurses of the procedure to take to avoid exposing themselves to potential attackers (Eugene et al, 1993). Total quality management or Organizational Intervention One of the widely used programs in prevention of violence against nurses in the emergency department is total quality management or organizational intervention. In this program, an organization takes the lead role in changing its staffing methods to reduce workload and improve work culture and the working environment. High priority is usually accorded to organizational intervention in averting workplace violence. Work design strategies include enhancing autonomy, promoting communication about job responsibilities and expectations and clarifications on managerial protocols or chains of command. For this program to yield positive results, intervention measures should be taken into account within a wider perspective of human resources. Studies have predicted that there is a relationship between minimization of hostile incidents against nurses in the emergency department and human resource policies. Minimization of violent incidences and the consequent reduction in workers injury may be accredited to support and educative initiatives like clinical supervision. A raise in regular permanent workers may be a factor in the minimization of hostile incidents. Toleration of hostile behavior is linked to experience since experienced members of staff in the emergency department tend to show higher tolerance attitude which can be enhanced as a portion of growing confidence in handling hostile patients. Management can gain from retention approaches considering the consequent expenses to orient new worker prevention programs as a result of staff turnover (Arnetz J.E., & Arnetz, B.B., 1998) Violence prevention program: Star program This is a program that has been developed to prevent violence against nurses through the use of weapons such as hand guns. It has been developed by the Center to Prevent Handgun Violence. Nurses are trained on means and methods of detecting patients in possession of weapons. The program has been effective in many emergency departments since the culprits of violence can not execute their intentions without weapons (Eugene et al, 1993). Risk Assessment programs Risk assessment programs are important programs especially in institutions identified as bearing security risk factors and other risk signals. The integration of efficient threat and risk evaluation will assist in ensuring that any interventions that are incorporated will best fit the intended situation. They can also identify any useful environmental modifications that may assist in reduction of crime. The increased rate of assaults linked with work assignment reassignments may be as a consequence of a wide range of aspects such as patient expectations to health care providers via coworker support or individual fatigue due to long working hours (Lipscomb & Love, 2002). Environment Modifications The essential staffing levels required to ensure security of health care staff may also be considered as apparent. Increased cases of hostility in the health care emergency department may also be attributed to short staffing as well as temporary staffing. A risk evaluation can also identify the relevance of precise documentation of incidents. This documentation is irrelevant in regard to validating the need for novel programs and the recognition of appropriate action plans. Some workers regard incident reporting as an implied entrance of professional failure. Risk evaluation and a commitment from the administration indicate that the antidote to rejection and resistance to occurrence reporting is a consistent effort to learn from events and to give timely feedback (Lipscomb & Love, 2002). Public awareness program This is a program that has been developed by the Center to Prevent Handgun Violence. The program is intended to inform the public of the violence attacks that takes place in emergency departments against the nurses. The program has been effective since many people have been able to restrain their relatives from possible attacks on nurses. The nurses are also informed of violent patients before they attend to them in the emergency departments. This program has been very effective since the community has been cooperative in assisting in the reduction of violence in emergency departments in institutions. The programs resulted to a growing awareness of violence in the emergency departments in 1980s. Conclusion A summary of the literature review discussed above is given in the table below: Author Country Study design Sample and intervention Types of programs methods Results and limitations Conclusion Beech B. Australia Case study Case study in nursing homes Zero tolerance to programs Case study Dependent on the condition of the patients in the health care centers This program is important in informing the nurses in the emergency department are informed on the appropriate measures to balance both the needs of their patients and their own needs and not to put the patient’s needs first. Flannery RB Australia Voluntary initiative Assault victims Assaulted Staff Action Program (ASAP) Evaluation Entails direct client services like evaluation, debriefing, defusing, and counseling services and follow ups. 92% of all the people that have used this program have reported that they can use the program once more while 81% reported the benefits hey go from the CISM services Anderson U.S.A Cross sectional study Newly recruited nurses and PSWs Educational programs Institutional policies and strategies Training of the nurses on conflict resolution skills, early detection and mentoring skills The programs needs to be directed towards particular types of resources and care recipients like those in the long-term medical care and cognitively impaired ones. Rippon T. J. Australia Cross sectional study Horizontal violence in the health care sector Aggression management program Application of management team Controls violence that emanates from patients Consequently able to depersonalize horizontal hostility and confront its proponent Allen D., & Tynan, H London Case study Nurses in the emergency department Behavior management program verbal prompt The type of training offered in the programs tends to charge the responsibility of controlling and managing of workplace aggression to the staff or the victims rather than the management of the institution Generally comprehensive in regard to positive effects on position change and minimization of violence cases. Barish U.S.A Case control study Behavioral emergency committee Reporting and monitoring violence Descriptive approach Gives information in regard to location, type and intensity of every violent incident Provide opinions in regard to prevention of violent incidences in future. Marin P. J London Case control study emergency department staff Post-assault Intervention structured post assault intervention Medical staff at the intervention centers should report issues such as: better responsiveness of the threats of violence targeting the emergency department staff, an enhanced capability of handling threatening or hostile situations and minimum exposure to violent incidences than the expected level. The programs assist in establishing a positive workplace environment in the care delivery system. Arnetz J.E., & Arnetz, B.B. Sweden Cross sectional study Permanent health workers Total quality management or Organizational Intervention Work design strategies Management can gain from retention approaches considering the consequent expenses to orient new worker prevention programs as a result of staff turnover. Enhances confidence in confidence in handling hostile patients Lipscomb, J. & Love, C.C London Cross sectional study Health care staff Risk Assessment Risk evaluation Increased cases of hostility in the health care emergency department may also be attributed to short staffing as well as temporary staffing. The essential staffing levels required to ensure security of health care staff may also be considered as apparent. Bourgeous M.S U.S.A Cross sectional study psychiatric disorders Post-violence strategies Risk evaluation violence is normally caused by stress due to injuries, long durations of wait and the prescription in the emergency rooms Care providers are often exposed to unpredictable patients and visitors with drug or alcohol impairment, or anguish from psychiatric disorders. Fitzpatrick, J. & Norbeck, J London Cross sectional study Health care staff OSHA program Searching strategies The program has been successful since more than 95% of the patients responded positively to the program while 93% of the nurse and 76% of the patients confirmed their support for the program and felt much safer in the medical organizations The searching policy was a success. Fitzpatrick, J. & Norbeck, J London Cross sectional study Nurses in the emergency department Health surveillance program evaluation Nonfatal injuries inflicted on nurses have not been properly documented The data collected in the program shows that various industries differ in terms of violence incidences experienced by their employees Eugene et al USA Case study California health department CAL-OSHA (Injury and Illness Prevention (IIP)) Program Hazard assessment Elements in the program include responsibility, compliance, communication, hazard assessment and hazard correction. The program has been specifically designed for industries that Cal-OSHA classifies as non-high hazard Eugene et al USA Cross sectional study Nurses in emergency department Employee assistance programs evaluation These programs assist the nurses in prevention of similar programs in future should they take place. The programs involve training of the nurses of the procedure to take to avoid exposing themselves to potential attackers. Eugene et al USA Cross sectional study Emergency departments Violence prevention program: Star program evaluation The program has been effective in many emergency departments since the culprits of violence can not execute their intentions without weapons Nurses are trained on means and methods of detecting patients in possession of weapons Lipscomb, J. & Love, C.C London Cross sectional study Health care staff Risk Assessment Environment modifications Increased cases of hostility in the health care emergency department may also be attributed to short staffing as well as temporary staffing. The essential staffing levels required to ensure security of health care staff may also be considered as apparent. Lundy London Case study Center to Prevent Handgun Violence Risk assessment evaluation The programs resulted to a growing awareness of violence in the emergency departments in 1980s. This program has been very effective since the community has been cooperative in assisting in the reduction of violence in emergency departments in institutions. Bibliography Allen D., & Tynan, H., 2000, Responding to aggressive behaviour: Impact of training on staff members’ knowledge and confidence. Mental retardation 38 (2): 97-104 Anderson, C., 2006, Training efforts to reduce reports of workplace violence in a community health care facility. Journal of professional Nursing 22 (5): 289-295 Arnetz J.E., & Arnetz, B.B., 1998, Violence toward health care workers. Prevalence and incidence at a large, regional hospital in Sweden. AAOHN Journal 46 (3): 107-114. Barish, R.C., 2001. Legislation and regulations addressing workplace violence in the United States and British Columbia. American Journal of Preventive Medicine 20 (2):149-154 Beech, B. 2001. Zero tolerance of violence against healthcare staff. Nursing standard 15 (16):39-41 Bourgeois, M.S., 2004, Communication skills training for nursing aides of residents with Dementia: the impact of measuring performance. Clinical Gerontologist 27(1) Flannery R.B., 1998, The Assaulted Staff Action Program (ASAP): Common issues in fielding a team Psychiatric Quarterly 69 (2): 135-141 Eugene, D & Baron, A., 1993, Violence in our schools, hospitals and public places: a prevention and management guide. California: Pathfinder Pub off California Fitzpatrick, J. & Norbeck, J., 1997, Annual review of nursing research, Volume 15., London: Springer Publishing Company Lipscomb, J. & Love, C.C. 2002, Violence toward health care workers- An emerging occupational hazard. AAOHN Journal 40(5):219-228. Lundy, K.S., 2001, Community Health Nursing., London: Jones & Barlett Publishers Marin, P. J. et al, 2004, An integrated approach for responding to aggressive and excessive behaviors in complex care settings. Victoria, BC: Nursing Directorate, British Columbia Ministry of Health. Rippon, T.J., 2000, Aggression and violence in health care professions. Journal of Advanced Nursing 31 (2): 452-460 Read More