Patient and Family Member Violent Situations in a Pediatric Hospital: A Descriptive Study

Improving clinician agreement and comfort through the development of a pediatric behavioral health huddle tool

BACKGROUND

Hospitalized pediatric patients with behavioral health (BH) diagnoses awaiting transfer can exhibit behaviors that may lead to workplace violence such as aggression. Workplace violence can lead to discomfort in caring for these patients. Huddles can be used as a tool to identify potential for violence, to help address workplace violence, and improve clinician situational awareness.

METHODS

Utilizing QI methodology, a BH specific huddle tool was created and implemented on an Acute Care floor that identified key components such as triggers and behavioral stability. Mixed methods were used to study the intervention including focus groups, surveys and measurement of agreement (surrogate for situational awareness). The aims of this quality improvement (QI) project were to 1) improve situational awareness by increasing agreement between team members 2) improve the overall comfort of the clinical team caring for BH patients by 10%.

RESULTS

Agreement between clinicians on patient stability increased by 20%. Comfort in caring for BH patients increased by 4%. Providers reported the tool increased their understanding (89%) and communication (81%) regarding plan of care.

APPLICATION TO PRACTICE

Standardized huddle tool can be utilized to increase situational awareness among team members caring for patients with behavioral health diagnoses and may help to address workplace violence.

The Prevalence of Type II Workplace Violence in US Nurses 2000 to 2022: A Meta-Analysis

BACKGROUND

Physical violence against nurses is a concern in the United States; however, its prevalence is not well quantified.

OBJECTIVE

We sought to describe the prevalence of workplace violence against nurses in the United States over a 22-year period.

METHODS

A meta-analysis was performed following a literature search of English texts through Scopus, CINAHL Plus, and Ovid MEDLINE. Inclusion criteria included the following: (1) primary reports of workplace violence incidents in the United States against nurses, (2) perpetrator was a patient, family member, or visitor, and (3) publications between January 1, 2000, and June 21, 2022. Reports where prevalence rates for nurses could not be calculated were excluded. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

RESULTS

Thirty-seven studies met the inclusion criteria; 27 030 nurses were included. The pooled prevalence of workplace violence was 0.35 (95% confidence interval [CI]: 0.29-0.42; Q = 3189.40; I2 = 98.87). Pooled rates of workplace violence increased from 30% in 2000 to 2004 to 43% in 2020 to 2022; however, the overlapping CIs indicate that the increase may not be statistically significant. The mean prevalence of reported workplace violence among nurses who work in the emergency department, in corrections, and psychiatric mental health settings (pooled prevalence = 0.59, 95% CI: 0.46-0.71) was higher than that of nurses who worked in all other settings (pooled prevalence = 0.24, 95% CI: 0.18-0.30).

CONCLUSIONS

Workplace violence is a significant and potentially increasing problem for nurses in the United States. This critical problem requires an effective response from nurse policymakers.

No excuses, no exceptions except with compassion: A narrative review of visitor aggression in pediatrics

Visitor aggression in pediatrics is a form of workplace violence that has not received much focus across pediatric health care systems. There are many different practices, strategies, and policies implemented across children's hospitals to mitigate visitor aggression on both clinical and organizational levels. To date, there has not been a published review on interventions in pediatrics to de-escalate the intensity of these circumstances in the context of providing care and treatment to children. The goals of this review are to identify and assess the efficacy of each effort implemented across diverse pediatric health care settings. This review also proposes research, organizational, clinical, and policy implications and considerations that could help inform future practice in hospital-based violence prevention. A narrative review of the literature identified eleven peer-reviewed studies that delineated practices, strategies, and educational efforts between 1994 and 2020. All studies were descriptive in nature. There were four cross-sectional studies, three qualitative studies, one mixed-methods study, two prospective studies (one of which also had a group comparison design), and one non-experimental study. The primary measures implemented across children's hospitals involved increasing security and police presence in patient care areas (n = 3), development of multidisciplinary workgroups to review and revise visitation policies (n = 2), crisis response teams (n = 2), and incident reporting systems (n = 2). Hospital risk management, administration, and clinical leadership teams were stakeholders involved in designing interventions across studies. Hospitals varied in allocation of support resources and in defining visitor aggression which contributed to mixed findings across studies.