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Sethi R, Lyver B, Gorla J, Singh B, Hanagan T, Haines J, Toppings M, Schulz-Quach C. Developing a customised set of evidence-based quality indicators for measuring workplace violence towards healthcare workers: a modified Delphi method. BMJ Open Qual 2024; 13:e002855. [PMID: 38964885 PMCID: PMC11227823 DOI: 10.1136/bmjoq-2024-002855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Workplace violence (WPV) is a complex global challenge in healthcare that can only be addressed through a quality improvement initiative composed of a complex intervention. However, multiple WPV-specific quality indicators are required to effectively monitor WPV and demonstrate an intervention's impact. This study aims to determine a set of quality indicators capable of effectively monitoring WPV in healthcare. METHODS This study used a modified Delphi process to systematically arrive at an expert consensus on relevant WPV quality indicators at a large, multisite academic health science centre in Toronto, Canada. The expert panel consisted of 30 stakeholders from the University Health Network (UHN) and its affiliates. Relevant literature-based quality indicators which had been identified through a rapid review were categorised according to the Donabedian model and presented to experts for two consecutive Delphi rounds. RESULTS 87 distinct quality indicators identified through the rapid review process were assessed by our expert panel. The surveys received an average response rate of 83.1% in the first round and 96.7% in the second round. From the initial set of 87 quality indicators, our expert panel arrived at a consensus on 17 indicators including 7 structure, 6 process and 4 outcome indicators. A WPV dashboard was created to provide real-time data on each of these indicators. CONCLUSIONS Using a modified Delphi methodology, a set of quality indicators validated by expert opinion was identified measuring WPV specific to UHN. The indicators identified in this study were found to be operationalisable at UHN and will provide longitudinal quality monitoring. They will inform data visualisation and dissemination tools which will impact organisational decision-making in real time.
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Affiliation(s)
- Rickinder Sethi
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Jaswanth Gorla
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | | | | | | | | | - Christian Schulz-Quach
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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Mesbah H, Rafique Z, Moukaddam N, Peacock WF. Predicting aggressive behavior in psychiatric patients in emergency department: A systematic literature review. Am J Emerg Med 2024; 80:44-50. [PMID: 38507846 DOI: 10.1016/j.ajem.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Aggression and violence are major concerns in emergency departments (EDs), and have negative consequences for patient and staff health and safety. Few validated tools exist for identifying patients at risk of agitation. This study conducted a systematic literature review to identify and summarize the scores that predict aggressive behavior in EDs. METHODS The search included articles published between Jan 1st, 1987, and Dec 31st, 2022, using the terms "aggress*," "violent*," "emergency," "acute," "score," or "scale." RESULTS Ten scores were found to be relevant, with eight of the developed scores intended for use in EDs. The Aggressive Behavior Risk Assessment Tool (ABRAT) was found to be sensitive (84.3%) and specific (95.3%). The Brøset Violence Checklist (BVC) was highly specific (99.4%), whereas the Violence Screening Checklist (VSC) was less sensitive (57.2%) and specific (45.7%). The violence and aggression (OVA)/BVC checklist was found to significantly decrease the number of security call activations (P < 0.001). The Behavioral Activity Rating Scale (BARS) and OVA/BVC scores were the shortest, with seven and six items, respectively. CONCLUSION The OVA/BVC checklist is a valuable tool for predicting and preventing violence in the EDs. Future prospective studies should investigate its effectiveness.
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Affiliation(s)
- Heba Mesbah
- Emergency Medicine Department, Baylor College of Medicine, Houston, TX, USA.
| | - Zubaid Rafique
- Emergency Medicine Department, Baylor College of Medicine, Houston, TX, USA
| | - Nidal Moukaddam
- Baylor College of Medicine, Psychiatry, and Behavioral Sciences, Houston, TX, USA
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Considine J, Shaban RZ, Fry M, Curtis K. Education interventions and emergency nurses' clinical practice behaviours: A scoping review. Australas Emerg Care 2024; 27:119-135. [PMID: 37980249 DOI: 10.1016/j.auec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. METHODS Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. RESULTS Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. CONCLUSION Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Sydney Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Centre for Population Health and New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia; Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Lyver B, Gorla J, Schulz-Quach C, Anderson M, Singh B, Hanagan T, Haines J, Sethi R. Identifying quality indicators to measure workplace violence in healthcare settings: a rapid review. BMC Emerg Med 2024; 24:29. [PMID: 38360571 PMCID: PMC10870575 DOI: 10.1186/s12873-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Workplace violence (WPV) in healthcare is a growing challenge posing significant risks to patient care and employee well-being. Existing metrics to measure WPV in healthcare settings often fail to provide decision-makers with an adequate reflection of WPV due to the complexity of the issue. This increases the difficulty for decision-makers to evaluate WPV in healthcare settings and implement interventions that can produce sustained improvements. OBJECTIVE This study aims to identify and compile a list of quality indicators that have previously been utilized to measure WPV in healthcare settings. The identified quality indicators serve as tools, providing leadership with the necessary information on the state of WPV within their organization or the impact of WPV prevention interventions. This information provides leadership with a foundation for planning and decision making related to addressing WPV. METHODS Ovid databases were used to identify articles relevant to violence in healthcare settings, from which 43 publications were included for data extraction. Data extraction produced a total of 229 quality indicators that were sorted into three indicator categories using the Donabedian model: structure, process, and outcome. RESULTS A majority of the articles (93%) contained at least 1 quality indicator that possessed the potential to be operationalized at an organizational level. In addition, several articles (40%) contained valuable questionnaires or survey instruments for measuring WPV. In total, the rapid review process identified 84 structural quality indicators, 121 process quality indicators, 24 outcome quality indicators, 57 survey-type questions and 17 survey instruments. CONCLUSIONS This study provides a foundation for healthcare organizations to address WPV through systematic approaches informed by quality indicators. The utilization of indicators showed promise for characterizing WPV and measuring the efficacy of interventions. Caution must be exercised to ensure indicators are not discriminatory and are suited to specific organizational needs. While the findings of this review are promising, further investigation is needed to rigorously evaluate existing literature to expand the list of quality indicators for WPV.
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Affiliation(s)
- Brendan Lyver
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jaswanth Gorla
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christian Schulz-Quach
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Centre of Mental Health, University Health Network, Toronto, ON, Canada.
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada.
| | - Melanie Anderson
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Brendan Singh
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Trevor Hanagan
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Jennifer Haines
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Rickinder Sethi
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre of Mental Health, University Health Network, Toronto, ON, Canada
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Cabilan CJ, McRae J, Ganzon K, Appo C, Rogers S, O'Sullivan M, Eley R, Snoswell C, Johnston A. Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study. J Emerg Nurs 2023; 49:360-370. [PMID: 36872199 DOI: 10.1016/j.jen.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). METHODS Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. RESULTS Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DISCUSSION Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.
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Recsky C, Moynihan M, Maranghi G, Smith OM, PausJenssen E, Sanon PN, Provost SM, Hamilton CB. Evidence-Based Approaches to Mitigate Workplace Violence From Patients and Visitors in Emergency Departments: A Rapid Review. J Emerg Nurs 2023:S0099-1767(23)00059-4. [PMID: 37074250 DOI: 10.1016/j.jen.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/11/2023] [Accepted: 03/19/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION This is a rapid review of the published evidence on the effectiveness of interventions for mitigating workplace violence against staff in hospital emergency departments. Focused on the specific needs of an urban emergency department in Canada, this project sought to address the question, "What interventions have evidence regarding effectiveness for addressing workplace patient/visitor violence toward staff in the emergency department?" METHODS Following Cochrane Rapid Review methods, 5 electronic databases (MEDLINE via PubMed, Cochrane CENTRAL, Embase, PsycINFO, CINAHL) and Google Scholar were searched in April 2022 for intervention studies to reduce or mitigate workplace violence against staff in hospital emergency departments. Critical appraisal was conducted using Joanna Briggs Institute tools. Key study findings were synthesized narratively. RESULTS Twenty-four studies (21 individual studies, 3 reviews) were included in this rapid review. A variety of strategies for reducing and mitigating workplace violence were identified and categorized as single or multicomponent interventions. Although most studies reported positive outcomes on workplace violence, the articles offered limited descriptions of the interventions and/or lacked robust data to demonstrate effectiveness. Insights from across the studies offer knowledge users information to support the development of comprehensive strategies to reduce workplace violence. DISCUSSION Despite a large body of literature on workplace violence, there is little guidance on effective strategies to mitigate workplace violence in emergency departments. Evidence suggests that multicomponent approaches targeting staff, patients/visitors, and the emergency department environment are essential to addressing and mitigating workplace violence. More research is needed that provides robust evidence on effective violence prevention interventions.
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Cabilan CJ, Eley R, Snoswell C, Jones AT, Johnston ANB. Inter-rater reliability of the occupational violence risk assessment tool for emergency departments. Australas Emerg Care 2023; 26:54-58. [PMID: 35906121 DOI: 10.1016/j.auec.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The three-item occupational violence (OV) risk assessment tool was developed and validated for use in emergency departments (EDs). It prompts review of each patient's aggression history, behaviours, and clinical presentation. However, confidence around representativeness and generalisability are needed before widescale adoption; hence we measured the inter-rater reliability of the tool among a large group of emergency nurses. METHODS A cross-sectional study was conducted between Sep 2021 and Jan 2022. Nurses were directed to a website that hosted an e-learning module about the tool. They were asked to apply the tool to two video scenarios of typical patient presentations. Demographic data, including years of emergency experience, were collected to contextualise their responses. Gwet's Agreement Coefficients (AC1) were calculated to determine inter-rater reliability. RESULTS There were 135 participants: typically female, under the age of 40 years, with more than 3 years of emergency nursing experience. Overall, there was excellent inter-rater agreement (AC1 =0.752, p = 0.001). This was consistent when years of ED experience was stratified: 0-2 years, AC1 = 0.764, p = 0.002; 3-5 years, AC1 = 0.826, p = 0.001; 6-10 years, AC1 = 0.751, p < 0.001; 11-15 years, AC1 = 0.659, p = 0.004; ≥ 16 years, AC1 = 0.799, p < 0.001. CONCLUSION The three-item OV risk assessment tool has excellent inter-rater reliability across a large sample of emergency nurses.
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Affiliation(s)
- C J Cabilan
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Robert Eley
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Centaine Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Queensland 4102, Australia
| | - Andrew T Jones
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Australia
| | - Amy N B Johnston
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland 4072, Australia
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Sammut D, Hallett N, Lees-Deutsch L, Dickens GL. A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings. J Emerg Nurs 2022; 49:371-386.e5. [PMID: 36585335 DOI: 10.1016/j.jen.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so. METHODS CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken. RESULTS Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area. DISCUSSION There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.
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Castner J. Changing Behaviors: The Behavior Change Wheel and Emergency Nursing. J Emerg Nurs 2021; 47:678-683. [PMID: 34330552 DOI: 10.1016/j.jen.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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