Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence

Abstract

Objectives: This study assessed the effectiveness of clinical education to identify patients with a high risk for violence and to reduce the frequency of violent incidents.

Design: A before and after design with an education intervention.

Setting: Data were gathered from the direct care staff and from records of violent/aggressive incidents which occurred on two adult medical wards at a teaching hospital in Western Australia.

Subjects: Nurses, Assistants in Nursing and Patient Care Assistants working on the study wards participated in the education intervention (n=65) and completed a questionnaire before and after the education. Details of 48 violent/aggressive incidents perpetrated by 21 patients were examined.

Intervention: An education program addressed four key areas (assessment, planning, implementation [crisis], post incident). Case studies and in-patient scenarios provided context, immediacy and relevance, and 77% of the staff completed the program.

Main outcome measure: Knowledge, confidence and capability of direct care staff to prevent/manage violent/aggressive incidents were measured. Incident data measured the frequency and recurrence of violence/aggression, and if perpetrators met the high risk criteria.

Results: Post education, knowledge increased significantly (p=0.001, CI 0.256-0.542), the use of verbal de-escalation increased significantly (p=0.011, 1df) and the frequency and recurrence of incidents decreased. All perpetrators met criteria indicating a high risk for violence.

Conclusions: Education and coaching provided by clinical experts resulted in increased knowledge, greater use of verbal deescalation and less incidents. However, more time/coaching is required to improve the perceived capability of clinical staff to manage these incidents.