Leadership

March 2, 2020

1

Running head: ANALYSIS OF PERTINENT HEALTHCARE ISSUES

Workplace Violence in Psychiatric Setting

Workplace violence (WPV) is an act of physical violence or other threatening disruptive behavior that occurs at the workplace (Wiley 2017). It can occur at or outside the work environment and can extend from intimidation, boisterous attack, to physical aggression and murder (Reference?). However, it manifests itself; WPV is a viable concern for managers and representatives (representatives? What do you mean by that term?) across the nation. The rate of violence at my INSERT NAME OF workplace is frequently examined and minimized by the nurse managers. However, it remains an ongoing problem as staff and patients often get severely injured, especially in the process of de-escalating combative patients. This issue attributes to the number of injuries accounted for, a factor that adds to the number of high turnover rates of employees, thereby creating staff shortage. According to my organizational data collected in 2018, the rate of WPV is highest among workers, 8.3 per 10,000 workers, and nurses are the most at risk (Mental health facility 2018).

Violence is not always propagated by patients towards staff, but also from staff towards patients as a result of a negligent and unethical reaction in containing a mentally ill patient. Agitation can rapidly heighten to animosity and rough conduct, and hence intense unsettling is viewed as a social crisis that requires a prompt response (Volavka, & Citrome 2012). Agitation is a highly sensitive situation. Thus, a rapid response by organizational administrators in planning vital interventions and protocols that will address the issue of WPV is considered crucial. The focus of this paper aims to analyze the issues of WPV and its impact on my organization. A literature review will focus on strategies for addressing the issue of workplace violence.

Articles were selected based on the content and their relevance to the selected healthcare issue. Reviewed articles were selected based on their content, peer-reviewed publication year, full text, evidence-based practice, and their relatedness to the healthcare issue in question. Good introduction

Review of Literature

Workplace violence is an extreme issue in health care and one of the enormous burdens to psychiatric-mental health nurses (Wiley 2017). Morphet, Griffiths, Beattie, & Innes (2019) explains that the prevalence of WPV in Colorado is as high as 62% (62% of what workers? Days worked?). Some triggers are variable and include patients' cognitive impairment such as confusion and dementia, drug and alcohol intoxication, physical discomfort and pain during treatment, and restricting movement such as applying restraint, redirecting, and transfer within the hospital (Morphet et al., 2019). Six trials involved a total number of 14 participants who were all nurses. Data collection was through electronic chart reviews, and interviews conducted were individuals and groups.

The result showed strategies and interventions for reducing WPV comprise risk assessment, safe assessment rooms, staff education particularly in de‐escalation, environmental design changes such as increasing visibility with lighting, toughened glass, and closed‐circuit cameras (Morphet et al., 2019). How much did they reduce violence?

McKenna, Smith, Poole, & Coverdale (2019) explains that WPV is a violent act that includes physical and verbal assaults directed at persons in the workplace. A study by McKenna et al., 2019 consisted of 68 nurses randomly selected representing various healthcare settings. A survey conducted, and results analyzed found that the most frequent verbal and physical assaults directed at the nurse were by the patient. A typical finding in the research emphasized the training on violence prevention, training on legal rights, improved nurse to patient ratios, and adequate time to evaluate and intervene resulted in a __% reduction (McKenna et al., 2019).

The articles were reviewed for evidence of the current practices in violent management and compared to my organizational statistical data of violence and injuries sustained by patients and employees. After careful review of the articles, I agree with (avoid first person language) the research results that implementation of a de-escalation rapid response team approach called "code white" (who are you quoting here? All quotes need a reference with page number) might be a solution to the problem.  How does a code white team work?

Conclusion

Workplace violence remains a critical issue in the mental healthcare environment (Volavka, & Citrome 2012). Promoting safety among patients and staff should be treated with high importance. Nothing can ensure that an employee or patient will not become a casualty of WPV; however, suggestions and recommendations to diminish the rate of WPV is essential. These include assessing the situation, implementing the de-escalation rapid response team. This process is adequate to be implemented to provide the ideal care in guaranteeing security among nurses and mental health patients during the intervention, hence diminishing the possibility of danger of injury and even death among healthcare workers and patients.  Good summary

Reference

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing:

Theory and Application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

McKenna. B. G., Smith, N. A., Poole, S. J., & Coverdale, J. H., (2019). Horizontal violence: an experience of registered nurses in their first year of practice. Journal of Advanced Nursing 42 (I), 90-9

Morphet, J., Griffiths, D., Beattie, J., & Innes, K. (2019). Managers' experiences of prevention and management of workplace violence against health care staff: A descriptive exploratory study. Journal of Nursing Management (John Wiley & Sons, Inc.), 27(4), 781–791. https://doi.org/10.1111/jonm.12761

Muralidharan, S. (2012). Containment strategies for people with serious mental illness. Cochrane Database of Systematic Reviews, (2), doi: 10.1002/14651858.CD002084.pub2

Volavka, J., & Citrome, L. L. (2012). Psychopharmacology of Aggression and Violence in

Mental Illness: A Review of Evidence-Based Treatments. Psychiatric Times, 29(4), 26-32.

Wiley KK. (2017). Nebraska Nurses Survey results. Making a world of difference: workplace violence and nursing. Nebraska Nurse, 40(4), 14–19.