Aggression Management Education for Acute Care Nurses: What’s the Evidence?

Abstract

A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on health care practices where little evidence exists. We welcome letters regarding this feature and encourage the submission of questions for future review. W orkplace violence-any threat or act of physical violence, harassment, intimidation, or other threatening behavior 1 -is a serious problem worldwide.2 Health care workers have an increased risk of workplace violence compared with workers in private industry.3 Nurses are the most common victims, 4-6 and patients are the main perpetrators (however, visitors and employees also can precipitate workplace violence).3 In 2014, the US Bureau of Labor Statistics 7 reported that serious workplace violence is more than 3 times higher in health care settings than other workplaces, with an incidence of 16.2 per 10 000 employees. Such estimates are conservative because of gross underreporting of workplace violence in health care settings. 2,3,[8][9][10] The percentage of nurses reporting having experienced verbal threats or actual physical violence ranges from 33% to 65% (Australia), 11 to 50% (Switzerland), 12 to 76% (US). 10 A systematic review 1 of 50 international studies revealed that patients' aggression toward nurses was similar in type (verbal abuse reported 3 times as often as physical assault in any setting), location and context (nurses in emergency departments commonly report higher rates), 10 individual consequences (physical injury, short-and long-term trauma), and organizational consequences (eg, absenteeism, low morale, job dissatisfaction, increased turnover, worker's compensation, heightened security, property damage, litigation) in different countries.8 Risk factors include individual influences such as history of aggression, psychiatric disorders, substance abuse, stress/frustration/ anxiety, powerlessness, and perceptions that violence is tolerated. Environmental risk factors for workplace violence include unrestricted access, inadequate security, long wait times, overcrowding, weekends/off-shifts, and lack of aggression management training.2,3,10,13,14 As education is a critical solution to arm nurses with knowledge, skill, and confidence to prevent and respond to situations involving workplace violence, the PICO (patient population, intervention, comparator, outcome) question for this evidence synthesis is, What effect does deescalation education have on nurse outcomes of aggression management knowledge and performance and clinical outcomes (incidence and severity of violence)? MethodThe strategy included searching the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE. Key words included violence, hospital violence, acute care, nurses, aggression management, and deescalation education. The search was limited to research from the past 10 years. Results Seven original research papers15-21 were...

The Gender-Related Impact of a Violence Management Training Program on Medical School Students—Preliminary Results

“…The participants’ ability to react to aggression with compassion and empathy is an important element of education [ 30 ]. Further exploration is necessary to establish to what extent teaching suitable aggression de-escalation methods (prevention), compared to teaching intervention methods (self-defense), affects the sense of self-efficacy.…”

“…The effectiveness of AMPs should be evaluated in relation to their objectives, which are mostly to deal with aggressive patients and teach skills useful for preventing aggressive behavior [ 30 ]. AMPs as a method enhance changes in attitudes, which in turn lead to changes in behavior.…”

Nurses’ Perceptions regarding Current Skills in Minimizing Patient’s Aggression at a selected Psychiatric hospital in Lesotho

“…The study is in keeping with the study conducted by Chang, Park, Jang, Ahn and Yoon (2019), who stated that 70% of nurses had experienced at least 1 type of verbal aggression whereby higher physical aggression and hostility were significantly related to greater verbal abuse experience. Furthermore, Halm (2017), echoed this sentiment, in the study conducted in Australia which stated that the percentage of nurses reporting having experienced verbal threats or actual aggression ranges from 33% to 65%.…”

A Clinical Nurse Leader-Guided Behavior Management Consult Team to Impact Workplace Violence Against Nurses

“…Training may favorably affect de-escalation practices for some but does not change attitudes or the ability to relate interpersonally to an aggressive or violent patient, a skill necessary as part of effective de-escalation. 10 Instead, many approaches are essential to make an impact on violence and aggression in organizations. 9 According to the ANA, WPV prevention within hospitals should include the following: (1) a zero-tolerance policy for violence, (2) a risk identification process, (3) an immediate and effective response to violence, (4) continual data collection, and (5) investigation of each WPV incident by an interprofessional team.…”