Introduction
Within the clinical practice, there is an issue of nurses neglecting to report violent incidents, especially when it comes to the environment of emergency departments. It is important to educate nurses about the need not to overlook this issue and eliminate the negative emotions that persist in emergency care settings. Despite the fact that in emergency rooms, nurses are put under pressure to ensure a high quality of care, it is imperative to preserve their personal well-being to be effective in the workplace. Thus, the purpose of the current paper is to present a PICOT question on the issue of reporting violent accidents as present evidence to supplement the research on the topic.
Background
There is a steady increase in the rate of violence at emergency departments as well as other medical settings. The escalation of patients’ pain and negative emotions accompanied by the presence of “disruptive individuals turn into verbal abuse or physical assault” (Gacki-Smith et al., 2009, p. 341). This issue was chosen for exploration because of the need to preserve a positive environment in emergency care settings as they call for the provision of care to patients requiring immediate treatment. As reported by Gacki-Smith et al. (2009), emergency department staff often lack education about the procedures of reporting, hazard assessment, and de-escalation, thus subjecting themselves and patients to potential risks.
Current practices and procedures do not reach the desired standard of reporting. The lack of competence of healthcare specialists in the area contributes to the inability to stop or prevent violent incidents as well as identify situations that are not severe enough to report to law enforcement. The absence of punishment for the disruptors of peace in emergency care is likely to be remembered, contributing to the increased changes of repeated violence. Therefore, this topic is extremely important for research due to the need to change the practice and ensure that healthcare specialists understand the ramifications of not reporting violent incidents. As the target population of the further PICOT question, nurses should be the primary recipients of the interventions targeted at reducing violence in emergency settings and ensuring effective reporting procedures.
As mentioned by Stene, Larson, Levy, and Dohlman (2015) in their study, nurses’ perception of the rates of violence occurrence point to an increase in the rate rather than a decrease. The Joint Commission (2018) also investigated the problem of violence at emergency departments, finding that 75% of aggravated assaults and 93% of all assaults against healthcare workers were attributed to patients. According to OSHA (2017), around 75% of approximately 25,000 workplace violence is reported in healthcare and service settings. These statistics point to the fact that the problem is extremely important to ensure the safety of nurses in the workplace and thus should be addressed immediately.
Nursing Theorist: Jean Watson
In the exploration of the issue regarding the reporting of violent incidents in emergency settings, Jean Watson’s theory of Philosophy and Science of Caring applies the most. The theory evolved from a philosophy initially; it is focused on the existence of various relational processes in which healthcare professionals engage when interacting with their patients, their families, as well as each other (Foss-Durant, 2014). Within the established creative factors, patients are expected to express their opinions and concerns; however, violence in healthcare settings remains an issue. Watson’s theory was chosen for the current exploration because the scholar suggested that humans could not be treated as objects and should not be separated from self and others. The process of caring-to-caring is expected to build transpersonal relationships and healing potential for everyone involved in the healthcare practice. The causative factors of balance and trust are helpful in supporting the process of identifying dangerous situations in a workplace setting and manage them appropriately.
The Evidence-Based Practice Question
The PICOT question to be answered with the help of research is the following:
- P (population): nurses and other healthcare professionals working in emergency department settings which fail to report incidents of violence;
- I (intervention): offer opportunities for scenario-based teaching to inform nurses about the effective ways of reporting incidents of violence;
- C (compared with): a number of incidents of violence in emergency department settings that are being currently reported;
- O (outcome): increase the rate of violent incidents reporting;
- T (time): within one year.
As each of the components of the relevant PICOT question has been identified, a question that will serve the future study can be developed. Thus, the developed question would be ‘in the population of nurses and other healthcare professionals working in emergency department settings that fail to report incidents of violence, can opportunities for scenario-based teaching inform nurses about the effective ways of reporting incidents of violence, increase the rate of incidents reporting compared with the current rate within a year?’
The Search for Evidence
In the search for the evidence necessary to support the research for answering the identified PICOT question, it was important to seek out information from reliable sources. To meet this objective, a search was conducted in such databases as PubMed, Cochrane Review, and CINAHL. The keywords searched in the mentioned databases were ‘emergency department violence, violence against nurses, nurses violence reporting, aggressing in emergency departments, emergency department violence prevention, nurses violence interventions.’ The exclusion criteria included research published before 2013 and non-peer-reviewed studies. Inclusion criteria for the chosen literature included the availability of full-text studies, both experimental and non-experimental designs, as well as the professional credibility of authors. It was important that the studies were written by experts in the fields of social and healthcare due to the influence of the research resulted in twenty research articles, of which five were used for the current evaluation.
It was important to include studies published between 2013 and 2018 because recent studies can provide more relevant information on the current practices of reporting cases of violence would show how severe the problem is. Potential and relevant research reports were those published in scholarly journals and had a traditional structure of research articles, including an abstract and a list of references used by their authors. It was also essential that researchers discussed their data collection and data analysis methods because of the need to determine whether the conducted procedures would yield reliable and measurable results. While not all studies included the limitations of research, it was a preferred category in the selection of studies because the acknowledgment of negative aspects of research would yield potential improvements in the future.
During the search for relevant literature, it was found that many studies on the topic of violence reporting in emergency settings were outdated. However, they included some useful information that could be potentially used in the paper. This issue points to the need to study the topic further and offer large volumes of research that would not be outdated but would provide desirable levels of expertise. As the exclusion criteria stated that no articles published before 2013 would be used, a large section of the articles resulting from the search had to be eliminated from the selection pool. Excluding non-peer-reviewed studies is explained by the fact that it is always best that the work of scholars is subjected to scrutiny from experts in the same field. Peer reviews are instrumental in checking the validity of research and ensuring that it can be published in the relevant literature. There were four studies in the selection pool that have not been peer-reviewed, which is why it was chosen to exclude them from using in the current paper.
Table of Evidence Matrix
Discussion on Implementation of a Practice Change
As nurses represent the key personnel involved in direct interactions with patients, they represent the population within the specific setting practice in which change will take place. In order to cater to patients’ needs and expectations, the change in practice will account for their preferences and values. The intervention defined by the PICOT question will require the implementation of systematic efforts and include leadership within the clinical practice, which is why patients will not be involved in the process.
The key stakeholders involved in the current project will include nurses, nursing managers, emergency department directors, and local policymakers. The interdisciplinary collaboration between them is essential to ensuring that all professionals within the intervention are on the same page in terms of goals, objectives, and procedures. Besides, the change team made of professionals in the field of healthcare can collaborate on the basis of developing suitable assessment and reporting tools associated with the management of ED violence occurrence. Giving the staff at emergency departments the education, support, and methods of reporting violent incidence are expected to reduce the number of violent acts remaining unreported.
It is expected that such barriers as the lack of resources, understaffing, and the lack of education would limit the implementation of change (Taylor & Rew, 2010). With the lack of resources that range from financial support to available tools within emergency departments, nurses will have fewer opportunities to identify violence effectively and report it to the relevant authorities. In the case of understaffing, nurses will not have enough time to attend to all issues at an emergency department because their duties would exceed their capabilities (Cheung, Lee, & Yip, 2017). This barrier can be eliminated through effective nursing management and scheduling. In addition, the establishment of positive work conditions and fair compensation for nurses is expected to increase their satisfaction, reduce turnover and subsequently reduce understaffing (Chien & Yick, 2016). The lack of education is a barrier that is expected to reduce change readiness and can only be eliminated with the help of appropriate training and the dissemination of information.
Evaluating Organizational Change Readiness
Scenario-based training represents an approach to learning design with participants in mind and aligns with the job performance of learners. The nurses involved in the training are expected to change their approaches to managing violent situations in emergency settings and be more proactive when dealing with patients exhibiting high risks of assault. Within the anticipation of nurses becoming more aware of violence and its reporting, there may be a potential barrier of them being hesitant to act. This barrier can be associated with both personalities of nurses as well as the nature of the situation at hand.
Before implementing scenario-based training in the context of emergency departments, it is important to address nurses’ concerns both in terms of their emotional well-being and professional responsibilities. Practitioners should feel secure in their practice settings, which is why it is important for nursing managers to ensure that facilities cater to the needs of their professionals and implement appropriate measures. In addition, work environments should be enhanced with the help of relevant tools and amenities, including technologies, that will make nurses’ practice easier.
Conclusion
In summary, it is worth noting that the problem of violence in emergency departments persists to this day. The implementation of effective efforts targeted at enhancing nurses’ proactiveness is essential because the lack of consistent efforts increases the likelihood of violence occurrence. The proposed PICOT question aims to identify the effectiveness of scenario-based training in helping nurses be more effective in determining cases of violence at emergency departments and reporting them to the police. In the exploration of relevant research articles on the topic of violence in healthcare settings, it was found that nurses lacked resources, education, and training to be proactive in violence management, which reinforces the limited efforts associated with addressing stressful situations in the workplace. It is notable that further research on this topic is needed, especially through applying the perspectives of patients to understand the reasons behind violence in healthcare settings.
References
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