Assignment: Identify barriers of implementation and how would you work to this issue

Assignment: Identify barriers of implementation and how would you work to this issue

Assignment: Identify barriers of implementation and how would you work to this issue

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Name one barrier for each that could impact the implementation of the guideline in practice. And explain how you would work through this issue.

Additional instruction: Please refer to the peer projects. Please see attached file.

Please provide reference within 5 years

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Work Place Violence: Blue Group CLC Project

Grand Canyon University: NUR 504

Work Place Violence

Problem Statement

Workplace violence (WPV) against emergency department (ED) nurses has become a nationwide problem and can negatively impact a nurse’s physical and psychological well-being as well as patients’.

Evidenced Based Practice Question

In the ED, is the implementation of clinical safety protocol decreases the prevalence of WPV?

Literature Review and Research Synthesis

ENA (2008) defines WPV as “any physical assault, emotional or verbal abuse, threatening, harassing, or coercive behavior in the work setting that causes physical or emotional harm”. According to ENA (2008), 54% of ED nurses surveyed had been verbally abused during a one-week period and 11% had been physically abused. Risk factors includes inadequate staffing and security, overcrowded waiting rooms, long waits, working alone and directly with volatile patients such as drug, alcohol, or with mental health problems, poor hospital design, and lack of policies and training on managing and preventing violence. Negative consequences of WPV against nurses includes acute stress, post-traumatic stress (PTS) symptoms, decreased productivity, physical injury, and even death (Gates, Gillespie & Berry, 2013). Gates and colleague (2013) state that PTS symptoms caused by WPV reduces the ability of ED nurses to cognitively focus on their work in comparison to their ability prior to an episode of violence. Therefore, violence can negatively impact a nurse’s physical and psychological well-being as well as other patients’. Unsafe working conditions are resulting in interference with the ability to provide high-quality care (DeNisco & Barker, 2016). Assignment: Identify barriers of implementation and how would you work to this issue

Violence can come from patients, families and visitors and often includes intimidation and harassment that can escalate to physical violence (Sharma & Sharma, 2016). Due to this increase prevalence, many ED nurses have or considered transferring to another department or facility or have even left the profession altogether (ENA, 2008). “Maintaining a safe work environment is a legal and ethical responsibility of health care administrators and nursing leaders” (Copeland & Henry, 2017, p. 65). To increase patient and staff safety, satisfaction, retention and to avoid more violence, stress, and turnover, ED management need to implement stronger policies, provide adequate staffing, increase security, consider structure redesign, and provide staff with proper violence training (Gates, Gillespie & Berry, 2013). Encouragement of staff to report any episodes of violence, advocate for their staff, and to communicate openly about issues and needs related to violence is imperative. Administration needs to educate their staff about the state laws against WPV and the resources available to nurses (ENA, 2008). If nurses are responsible for taking care of others, then they need to be able to take care of themselves. To conclude, WPV and lack of healthcare worker safety is a significant problem in health care and needs to be further addressed because of its impact on patient care and safety, as evidenced by the numerous research articles.

Clinical Protocol

The following clinical protocol should be followed to make a reasonable effort to prevent WV of any kind and have a safety atmosphere. To be a high reliable organization it is imperative to utilize various Highly Reliable Organization (HRO) tools. To keep an atmosphere which is free from WV when any employee feels concerned they can utilize the following tools: STAR, Stop Think Act Review & CUS, I am Concerned I am Uncomfortable this is a Safety issue. Leaders must immediately respond and investigate any suspicions or knowledge of a current or potential threatening situation. It is appropriate to convene a Threat Assessment Team to include Human Resources, Employee Health, Security and the next level of management. Any employee with concerns may be referred to the Employee Assistance Program for further evaluation and assistance regarding counseling and certified treatment. All reports of violence will be taken seriously. The environment is a non-punitive one for those who report, in good faith, any threatening or disruptive behavior.

Implementation Plan

The implementation plan begins with designing a confidential pre-test, of ten structured questions, to be administered via email to RNs at a Level 1 Trauma Center as a baseline study. Only RNs is to receive the questionnaire. Questionnaires will be emailed, and involvement is voluntary. Results are to be collected and logged by educators. The facility has in place 24- hour security, mandatory de-escalating training for all staff, panic buttons, and controlled badge access to the department. The purpose of this implementation plan of cross- sectional survey is to establish RN exposure to WPV in the ED, barriers to reporting violence, and perceptions of safety, in addition to improve workplace safety related to violence. Implementation plan goal is to improve workplace safety, understand the culture of tolerance and exposure, and identify and reduce barriers to reporting of violence experienced.

Timeline

The questionnaire will be emailed to all RNs on a Monday. Request to respond is set to two weeks and results will be tallied by ED educators over 1-2 days. Results will be transcribed and reported to ED leadership directors for appropriate follow-up within 1-2 weeks. An appreciation email and results will be sent to RNs for their participation. An action plan will be developed for identified risk, barriers, and areas for immediate action within 2 weeks following department head review.

Criteria for Evaluating Outcomes

The Centers for Disease Control and Prevention [CDC] outline four types of evaluation techniques; formative, process/ implementation, outcome/ effectiveness, and impact evaluation (CDC, n.d). The criteria for evaluating outcomes of the pre-test structured survey will use the impact evaluation. The criteria for using the evaluation technique, is the results of the survey will be used to provide evidence for policy or funding that can be implemented in the institution related to the action plan goals.

Barriers, Obstacles, and Drivers for change

Barriers to this study include non- participation, single institution assessment, and institutional culture of perceived safety regarding terminology of WPV. Obstacles to getting staff participation could include those on medical leave, vacation, or not willing or able to respond to emailed survey. Other obstacles may be interpreting results in a measurable manner, as some responses may be subjective. To recruit drivers for change, sending an email requesting staff involvement or interest in improving safety in the ED as a team champion, would gain access and cooperation of those that would be implementing change. Requesting ED leadership involvement would also serve as a benefit for drivers of change, as they would provide daily reminders, guidance, and suggestions to staff for reporting violence and prevention measures. Requesting security involvement and Hospital Safety & Reliability would only improve future measures to reach outcome goal.

References

Center for Disease Control and Prevention (CDC). (n.d.). Types of Evaluation. Retrieved from https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf

Copeland, D., & Henry, M. (2017). Workplace violence and perceptions of safety among Emergency department staff members: Experiences, expectations, tolerance, reporting, and recommendations. Journal of Trauma Nursing, 24(2), 65-77.

DeNisco, S., & Barker, A. (2016). Advanced Practice Nursing (3rd ed.). Burlington, MA: Jones & Bartlett Learning. doi:10.1097/JTN.0000000000000269

Emergency Nurses Association (ENA). (2008). Violence in the emergency department: Findings from ENA’s study of workplace violence against registered nurses. Presented at the ENA Annual Conference, Minneapolis, MN. Retrieved from www.ena.org/practice-resources/workplace-violence.

Gillespie, L., Gates, D., & Berry, P., (2013). Stressful incidents of physical violence against emergency nurses. The Online Journal of Issues in Nursing, 18(1).

Sharma, R., & Sharma, V. (2016, April 6). Work place violence in nursing. Journal of Nursing & Care, 5. http://dx.doi.org/10.4172/2167-1168.1000335