Are Staff Training Interventions Effective in Handling and Reducing the Frequency and Intensity of Patient Aggression - Research Proposal Example

Nursing Research 2 Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecture Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Introduction Patient aggression is a serious issue that affects the morale of workers in many nursing institution. In most cases the handling of patient aggression in most institution is a thorny issue. Health institutions have to balance between the safety of staff and the rights of patients while intervening in cases of patient aggression. The problem of patient aggression mostly affects nurses who work with mentally ill patients. According to Abderhalden et al (2008) 44 per cent of clinical staff and staggering 72% of nursing staff working with mentally unwell staff felt unsafe. The effects of aggressive patient behavior include injuries to other patients and staff. In some cases the injury are so severe that the affected member of staff has to miss work for several days. The management of patient aggression remains contentious and there is much debate about the effectiveness of various intervention used in patient intervention. This research seeks to investigate the effectiveness of Staff training interventions in handling and reducing the frequency and intensity of patient aggression. The sample for this research will be a group of 42 nurses in their third year of nursing practice at a Sydney hospital. The sample will be divided into 3 groups; two thirds of this group will form the treatment group which will be offered training on how to handle aggressive patients. The treatment group will be further divided into two groups according to the mode instruction delivery used to deliver the training; internet or ordinary classroom. The second group will form the control group which will not be offered any training. The research seeks to support the hypothesis that staff training is the most effective intervention in preventing patient’s aggression. The contention over the effectiveness of various methods to handle patient aggression emphasizes on an ethical approach to the issue (Agervold and Andersen 2006). As an intervention staff training leads staff to showing greater kindness to patients and patient aggression is handled in an orderly manner. Staff training is a more effective intervention in improving patient staff relationships which are viewed by the interactional model (Nau et al 2009). This research can also propose an effective alternative to the controlling method which worsens the nurse patient relationship. Secondly, this research will compare the effectiveness of delivery methods for aggressive management training by comparing the ordinary internet and classroom training. With internet training becoming a preffered method for on job training for nurses, testing its effectiveness against classroom training will enable future health care administrators when deciding which mode of delivery to adopt for training programs. This research can also contribute knowledge that can assist in the improvement of care models which have been recommended as the best approaches to reduce patient factors by influencing staff factors (Nau et al 2009). If the research hypothesis is confirmed, this research will contribute further evidence that staff training is the best intervention in protecting nurses from aggressive patients. Applications of the recommendations of this research will also lead to improved service deliver in medical institution as incidents of aggression towards nurses reduce. Nurses will be able to do their work without being afraid of patient attacks. Methods Inclusion: The population for this review will include nurses below the age of 30 years who work in nursing environments with mentally ill patients. The sample will include both male and female participants as the gender of the nurse experiencing aggression is irrelevant. Practicing for more than 3 years will also be another inclusion criteria considered in this study. Nurses who will participate in this case study are also expected to be in active service. This inclusion Criteria is chosen, as nurses at this age are easier to train and have not experienced the effects of burnout. Previous experience of handling patients with aggressive behavior is an important criterion, as it provides the nurse with an opportunity to apply the skills gained. Particularly in the control group those who have already handled an aggressive patient already have an established habit for handling patient aggression. Nurses working in various care environment handling adult patients will be included in the study as the impact of adult patient aggression is greater than that of children. The intervention will include a two week training program, while the control group will not be taken through training which is the case in most medical institutions (Irvine et al 2012). Studies with shorter durations of aggressive training will also be included in the review, as studies with training intervention going beyond a week are few (Kynoch, Wu and Chang 2009). The review will include articles published between 2000 and 2013. The research will only review articles that report the results of primary research as they provide more valid evidence to address the research problem in this study (Bettany-Saltikov 2010). The outcomes that are of interest to this review include reduced incidences of patient aggression, reduction of intensity in patient aggression and quick de-escalation of patient aggression. Exclusion The study will exclude practicing nurses above the age of 30, as the training program is likely to be less effective on this group. Nurses who have not been actively practicing will also be excluded from the study, as the study is interested in application of learned skills to practice problems. Studies with sampling less than 5 subjects will also be excluded from this study, as they results are not a true representation of the whole population. Nurses with an existing anger management problem will be excluded from this study as their handling of aggressive patients may be affected by this problem. Nurses who have never experienced an incidence of patient aggression are also excluded in the case study as they have not established a routine of dealing with patient aggression problems (Irvine et al 2012). The study also excludes other medical staff who work in care environment as it focus is nurses who are in constant contact with patients who are aggressive. The study also excludes nursing students as their lack of experience may hinder their ability to handle aggressive patients. Nurses who work in pediatric care are also excluded from this research as incidents of patient aggression are rare in their practice (Kynoch, Wu and Chang 2009). Other intervention for reducing patient aggression including pharmacotherapy, physical restraint will be excluded from this study as their effectiveness is not the focus of this review (Nau et al 2009). Interventions that also combine staff training with the aforementioned interventions will also be excluded from this research, as they make it difficult to distinguish the effects of staff training in reducing patient aggression (Hobday et al 2010). All articles reporting unpublished results were also ignored for this research as the integrity of their results could not be established. Articles published before the year 2000 were also excluded from the review as they do not represent recent advances in handling inpatient aggression (Bettany-Saltikov 2010). Outcomes like patience happiness and patient perception of care environment will be excluded as thus study focuses on the effect of staff training on patience aggression. Search Strategy This research will employ electronic search to locate studies on patient aggression published between 2001 and 2013. The main databases used to conduct this search include: MEDLINE and Cochrane clinical trials. With over 22 million citations MEDLINE provides the widest source of information of recently published clinical trials on patient aggression and other medical research subjects (Wilczynski 2004). Cochrane clinical trials is chosen as it is easier to search for relevant articles in a database that contains clinical trials only. MEDLINE provides an auto complete feature where search suggestions are provided which can assist in generating keywords to search the other database. Research question: Are Staff training interventions effective in handling and reducing the frequency and intensity of patient aggression. The keywords to be used are: “patient aggression” or “inpatient” or “resident aggression” or “aggressive residents” or “aggressive patients” or “ward aggression” or ‘hospital aggression” or “violent resident” or “violent inpatient” and “staff training interventions” or “nurse training” or “aggression handling training”, and “aggression intensity”, “aggression frequency” or “aggression de escalation” (Nau et al 2010). The keyword aggression and its variants aggressive and violence are employed to retrieve articles where the main theme addressed is aggressive behavior in care settings. By using these keyword variants all articles dealing with inpatient aggression are retrieved from the two databases (Bettany-Saltikov 2010). Resident, patient and inpatient are other variants with the same meaning that are used to widen the search results of the present review; this makes sure any studies on patient aggression are not left out because they use a different word which means patient. The concept of staff training intervention is used to narrow down the search to articles focusing or including staff intervention as the main type of intervention for handling inpatient aggression. The use of the above mentioned keyword help in increasing the precision and sensitivity of the search results retrieved for this study (Bettany-Saltikov 2010). They also assist the research save time by narrowing the results to only those searches with relevant information for this cases study. Through the keyword search the themes of patient aggression, staff training intervention and effective handling of patient aggression are supposed to emerge. Search strategy Following the keyword search the articles and abstracts will be inspected for relevance and further citations obtained from the references of these articles (Bettany-Saltikov 2010). The references obtained will be divided between researchers for a detailed review and extraction of data. The articles that are most relevant and containing empirical evidence will be selected for this review. Research question: Are Staff training interventions effective in handling and reducing the frequency and intensity of patient aggression. 1. patient aggression* 2. aggre* 3. reside* 4. inpatient or 5. resident aggression or 6. aggressive residents or 7. aggressive patients or 8. ward aggression or 9. hospital aggression 10. or violent resident or 11. violent inpatient and 12. Inpatient violence 13. Patient violence 14. violen* 15. staff training interventions, 16. Staff training 17. Nurse training 18. and aggression intensity* 19. inten* 20. aggression frequency or 21. aggression de escalation 22. Reduced aggression 23. Aggre* AND Resident 24. Aggre* AND Patient 25. Aggre* AND inpatient 26. Aggre* AND Hospital 27. Aggre* AND Ward 28. Violen* AND Resident 29. Violen* AND Patient 30. Violen* AND inpatient 31. Violen* AND Hospital 32. Violen* AND Ward 33. Aggre* AND Resident AND Staff training 34. Aggre* AND Patient AND Staff Training 35. Aggre* AND inpatient AND Staff Training 36. Aggre* AND Hospital AND Staff Training 37. Aggre* AND Resident AND Nurse Training 38. Aggre* AND Patient AND Nurse Training 39. Aggre* AND inpatient AND Nurse Training 40. Aggre* AND Hospital AND Nurse Training 41. Violen* AND Resident AND Staff Training 42. Violen* AND Patient AND Staff Training 43. Violen* AND inpatient AND Staff Training 44. Violen* AND Hospital AND Staff Training 45. Violen* AND Ward AND Staff Training 46. Violen* AND Resident AND NurseTraining 47. Violen* AND Patient AND Nurse Training 48. Violen* AND inpatient AND Nurse Training 49. Violen* AND Hospital AND NurseTraining 50. Violen* AND Ward AND Nurse Training 51. Violen* AND Resident AND Staff Training 52. Violen* AND Patient AND Staff Training AND Aggression intensity 53. Violen* AND inpatient AND Staff Training AND Aggression intensity 54. Violen* AND Hospital AND Staff Training AND Aggression intensity 55. Violen* AND Ward AND Staff Training AND Aggression intensity 56. Violen* AND Patient AND Staff Training AND Aggression frequency 57. Violen* AND inpatient AND Staff Training AND Aggression frequency 58. Violen* AND Hospital AND Staff Training AND Aggression frequency 59. Violen* AND Ward AND Staff Training AND Aggression fequency 60. Violen* AND Patient AND Staff Training AND Aggression intensity 61. Violen* AND inpatient AND Staff Training AND Aggression intensity 62. Violen* AND Hospital AND Staff Training AND Aggression intensity 63. Violen* AND Ward AND Staff Training AND Aggression intensity 64. Violen* AND Patient AND Staff Training AND Aggression De-escalation 65. Violen* AND inpatient AND Staff Training AND Aggression De-escalation 66. Violen* AND Hospital AND Staff Training AND Aggression De-escalation 67. Violen* AND Ward AND Staff Training AND Aggression De-escalation 68. Violen* AND Resident AND Nurse Training AND Aggression intensity 69. Violen* AND Patient AND Nurse Training And Aggression intensity 70. Violen* AND inpatient AND Nurse Training and aggression intensity 71. Violen* AND Hospital AND Nurse Training Aggression intensity 72. Violen* AND Ward AND Nurse Training Aggression intensity PICO, inclusion/exclusion criteria, and search strategy contribution in knowledge in patient aggression The problem area in this research is identified as patient aggression. Through this review I have been able to gain a greater understanding of patient aggression and why it is a serious problem that threatens the success of nursing practice. Through analysis of various interventions for the prevention and handling of patient aggression I was able to establish that little is known about the effectiveness of these interventions. I established there is a gap in knowledge about the effectiveness of staff training as an intervention to handle patient aggression. This is not the only gap as other interventions like pharmacology; physical training and individualized training remain poorly researched (Kynoch, Wu and Chang 2009). The comparison made in this research involves recording how a trained and untrained nurse reacts to incidents of patient aggression. The research hypothesizes that nurses with training to handle aggressive patient are more likely to interact with patient in a way that reduces incidents of patient aggression, where these incidents occur they are less intense and the training enables nurses quickly de-escalate the aggression. These outcomes can assist the development of a course in handling patient aggression. An analysis of literature on intervention also indicates that the effectiveness of other intervention apart from staff training needs to be investigated. The exclusion/Inclusion criteria for these assignments have taught me the importance of controlling subjects for any research so the effects of the interventions are clearly legible. The inclusion/Exclusion criteria are an indication of practice situation where the aggression training program may not be effective in handling patient aggression. Through the exclusion/exclusion criteria I was able to learn that nurses have their own preferred style of dealing with patient aggression if they have been involved in incidents of patient aggression. Similar, to the interventions, the exclusion criteria is also an indicator of other research areas that needs to be investigated to better understand patient aggression. Through the search strategy I was able to understand the various word variants that are used to describe patient aggression according to the situation it occurs in. Through the definition of these word variants I was able to gain greater insight into the problem of patient aggression. The search strategy also presents evidence that patient aggression occurs in various care settings. The various outcomes described as reduction of aggression intensity and frequency, alongside de-escalation of aggression incidents point to objectives of patient aggression handling intervention. The search strategy also establishes the skills that any staff training program should impart nurses so they are able to effectively handle the problems of patient aggression. References Abderhalden, C, Needham, I, Dassen, T, Halfens, R, Haug, HJ, & Fischer, JE 2008, ‘Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial’, British Journal of Psychiatry, vol. 193, pp. 44-50. Agervold, M & Andersen, LP 2006, ‘Incidence and impact of violence against staff on their perceptions of the psychosocial work environment", Nordic Psychology, vol. 58, no. 3, pp. 232-247. Bettany-Saltikov, J 2010, ‘Learning how to undertake a systematic review: part 2’, Nursing Standard, vol. 24, no. 51, pp. 47-56 Hobday, JV, Savik, K, Smith, S, & Gaugler, JE 2010, ‘Feasibility of Internet Training for Care Staff of Residents with Dementia: The CARES® Program’ Journal of gerontological nursing, vol. 36 , no. 4, p.13. Irvine, B, Billow, MB, Gates, DM, Fitzwater, EL, Seeley, JR, & Bourgeois, M 2012, ‘An Internet Training to Reduce Assaults in Long-Term Care’, Geriatric Nursing, vo. 33, no.1, p. 28-40 Kynoch, K, Wu, C. JJJ, & Chang, AM 2009, ‘The effectiveness of interventions in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting: a systematic review’, The JBI Database of Systematic Reviews and Implementation Reports, vol. 7, no. 6,pp. 175-223. Nau, J, Dassen, T, Needham, I, & Halfens, R 2009, ‘The development and testing of a training course in aggression for nursing students: a pre-and post-test study’, Nurse Education Today, vol. 29, no. 2, p. 196. Nau, J, Halfens, R, Needham, I, & Dassen, T 2010, ‘Student nurses’ de-escalation of patient aggression: A pretest–posttest intervention study’ International journal of nursing studies, vol 47, issue 6, p. 699. Wilczynski, NL, Haynes, RB., Lavis, JN, Ramkissoonsingh, R, & Arnold-Oatley, AE 2004, Optimal search strategies for detecting health services research studies in MEDLINE. Canadian Medical Association Journal, vol 171, no. 10, pp. 1179-1185. Read More