Reducing violence in the emergency department, improving perception of safety: An aggression prevention team approach
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Marilyn Riley, DNP, MSN, APRN-BC, FNP, NE-BC
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- Beta Phi
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Problem Statement and Purpose: Acts of aggression towards nurses has reached never-before-seen levels in Emergency Departments (ED) across the United States (US), and it increases by 15% or more every year. Nurses and ED staff are subjected to violent patients, daily. Nurses often do not feel they have the skills to intervene safely when patients become aggressive, and these behaviors can escalate to harmful levels. Nurses must have a safe environment to practice; therefore, it is imperative violence stops. This DNP project implements an Aggression Prevention Team (APT) to respond in the ED when patients or visitors become aggressive and to improve the nurses’ perception of safety.
Population and Setting: The participants were ED nurses in a rural, 25-bed Critical Access hospital.
Project Design: The purpose of the quality improvement project was to address the clinical problem of aggressive patients and the perception of safety among nurses in the ED.
Evidenced-Based Procedure: This DNP project was the implementation of an APT to intervene when patients’ behaviors escalate.
Evaluation: The nurses’ perception of safety increased based on the mean of the pretest score compared to posttest score. The sample size was nine, and therefore, statistical significance could not be determined. There was, however, an increase in reporting WPV incidents and every aggressive patient that the APT intervened on, the EMR was flagged.
Results: Survey was sent to all fifteen RNs. Survey response rate was 60% (n=9). Four questions focused on the nurse’s perception of safety. All four questions showed an increase in the mean score when pretest and posttest were compared. It can be inferred that by scoring higher after the intervention, the nurses’ perception of safety increased. During the 3-month pilot program, the APT responded thirteen times. At the conclusion of the pilot, nurses responded with feelings of improved perception of safety knowing the team was available in aggressive patient situations.
Conclusion and Implications: The ED is an environment where WPV occurs on a regular basis. The perception of safety is influenced by supports in place, such as nursing supervisor, security personnel and the APT. Implementing an APT in the ED has improved the perception of safety among the nurses. Nurses who care for patients that are aggressive, feel supported by the APT and feel more confident in caring for these patients, because they have the additional support the APT offers. Nurse leaders should facilitate effective WPV interventions, such as developing an APT, and reporting programs to provide nurses with a safe environment to practice.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 28317062; ProQuest document ID: 2496540285. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type | DNP Capstone Project |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Quality Improvement |
Research Approach | Translational Research/Evidence-based Practice |
Keywords | Agressive Patients; Emergency Department; Multidisciplinary Team; Workplace Violence; Workplace Safety |
Grantor | The University of Alabama in Huntsville |
Advisor | Frith, Karen; Ivory, Cathy |
Level | DNP |
Year | 2020 |
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