Journal of the American Psychiatric Nurses Association最新文献

BackgroundIn the United States, it is estimated that 75% of healthcare workers report encountering workplace violence. Assaults on healthcare workers are associated with increased turnover rates, job dissatisfaction, trauma, and an inability to complete job tasks.AimsThe purpose of this quality improvement project was to evaluate the effectiveness of an education program to increase healthcare workers' knowledge and confidence in managing agitation and violence.MethodsThe project used a single group, pre- and post-test design to evaluate an educational intervention, a modified Awareness, Vigilance, Avoidance, Defense, and Escape/Environment (AVADE) program, using the Confidence in Coping with Patient Aggression Instrument (CCPAI), a 30-day post-intervention follow-up, and a post-violent incident follow-up. Quantitative data were analyzed using descriptive statistics and paired t-tests, and qualitative data were analyzed using content analysis of an open-response question on the post-violence and 30-day follow-up surveys.ResultsThackery's CCPAI was completed by 130 participants, across 20 different departments, and 13 job titles. The modified AVADE program was found to increase confidence among healthcare workers when coping with patient aggression.ConclusionAn educational intervention emphasizing de-escalation techniques, situational awareness, self-defense, appropriate restraint use, legal considerations, and case studies increased healthcare workers' confidence in managing patient aggression. According to a 30-day follow-up survey, staff members applied at least one of the strategies taught during the course to handle violent incidents within a month of completing the training.

Background: Violent behavior by patients on psychiatric units is a topic that has received considerable attention, particularly with regard to its consequences for nursing staff. While studies have sought to identify predictors of violence by inpatients, there is a dearth of research on dynamic risk factors, particularly anger.

Aims: The present study investigates the viability of assessing anger among patients on an acute civil commitment psychiatric hospital unit and to examine its association with aggressive behavior.

Methods: We evaluated the psychometric properties of several patient-rated anger assessment instruments and tested whether anger was predictive of subsequent patient-rated and nurse-rated aggressive behavior during the hospital stay of 42 patients. A brief, semi-structured diagnostic interview and measures of depression, early trauma, and coping were also used.

Results: Patients' self-ratings of anger, across all the psychometric scales, had high internal consistency and high concurrent validity, along with convergent and discriminant validity. Patient-rated anger was associated with patient-reported physical and verbal aggression and was prospectively predictive of aggressive behavior observed by psychiatric nurses, controlling for age, gender, and depression.

Conclusions: Patients on an acute psychiatric unit can self-report anger that bears on their risk for short-term aggressive behavior. The value of nurse involvement in monitoring patients' anger on inpatient psychiatric units is discussed, along with nurse-supported anger treatment programs.

Background: Assaults on nurses from patients or other nurses are endemic in healthcare settings. Still, nurses underreport or are silent about workplace aggression. Nurses' silence is embedded in social and organizational structures that discriminate against them and make speaking up unsafe.

Aim: The aim of this article is to examine professional identity attributes and how they intersect with prevailing social and organizational cultural norms to suppress nurses' voices. To determine how professional identities are gendered socially and culturally, a keyword focused cultural inquiry was conducted.

Methods: Attributes identified by keywords were extracted from 20 research reviews or data-based studies. Ten studies that reported results as linguistic data identified attributes of professional nurses; an additional 10 studies of this kind reported attributes of professional women outside the discipline. The keyword attributes were quantified then compared using word cloud analysis. The Master Narrative Framework was used to situate these identities within master narratives of gender and violence.

Results: Both identities examined were composed of terms socially and culturally attributed to women including "compassionate, respectful, a listener, kind, honest, empathetic, trustworthy, gentle, caring, and friendly." Nurses' identity attributes were reported as qualities of a good nurse while professional women attributes were presented as sources of gender discrimination.

Conclusions: Speaking up is critical to understanding workplace violence, yet nurses do not routinely report aggression or take action to prevent violence in their workplace. Understanding their silence as a response to gender discrimination provides potential avenues for enabling nurses to speak up to improve their work conditions.

Objective: To explore an innovative model for nursing administration practice in which a trauma-informed care approach is applied to staff and personnel management. This model is applicable especially for preventing workplace violence and managing its aftermath in psychiatric care facilities.

Methods: This discussion article presents a conceptual model for practice called NEW LENS (Nurses who Experience Workplace violence, Leadership to meet Expectations and NeedS), which is based on the BITTEN trauma-informed care framework. A model case exemplar is used to illustrate current nursing administration practices and to contrast them with a trauma-informed care approach to staff and personnel management.

Results: The model case exemplar highlights how the implementation of a trauma-informed care approach for nurses and staff could potentially impact the psychiatric work environment. Additionally, the model case exemplar suggests current administrative approaches may not adequately address the cumulative effects of workplace and personal trauma on staff responses to violence.

Conclusions: There is a need for further research on trauma-informed care in psychiatric nursing. Specifically, systematic exploration is required to understand how trauma-informed care strategies in nursing administration can address the intersection of workplace and personal trauma and improve staff resilience and safety.

Introduction: Workplace violence (WPV) in healthcare is detrimental to staff and institutions. The prevalence of events continues to increase despite efforts to mitigate events. WPV is associated with psychological and physical consequences and has been attributed to healthcare workers leaving the field, further contributing to the shortage of frontline healthcare staff. Healthcare workers often underreport WPV events due to cultures of acceptance, lack of knowledge of resources, and feeling unsupported during or after an event.

Aim: This quality improvement project aimed to implement a WPV bundle and evaluate the effectiveness of staff utilization of WPV resources, perceived confidence, knowledge, and support during and after WPV events in a general surgery unit.

Method: A hybrid education bundle, named the Violet Education Bundle, includes education for nurses on de-escalation techniques, incident reporting, standardization of shift-change huddle reporting, and resources for psychological support. A single-group, pre- and post-test design was utilized, and a paired t-test was employed to test for statistical significance.

Results: With 23.2% of staff (N = 20) completing both the pre-/post-survey (support, confidence, knowledge, and resource utilization sections) at both time points, no pre- to post-implementation outcome increases were statistically significant.

Conclusion: Though the 60-day follow-up might have contributed to the null findings, nurses anecdotally expressed that they found the resources valuable and appreciated having them in one place. Future research should include an assessment of effectiveness for improving staff confidence, knowledge, perceived support, and reduced incidence and complications of WPV events over a sustained period of time.

ObjectivesThe use of seclusion and restraint is common in hospitals, particularly in adult psychiatric settings. This pilot evaluation project assessed the impact of a web-based educational intervention on the knowledge, practices, and attitudes of front-line nurses concerning seclusion and restraints and on the actual use of restraints and seclusion in an inpatient psychiatric hospital setting.MethodsA quasi-experimental, pre- and post-assessment design was used to evaluate the impact of a 20-min targeted education intervention on knowledge, practices, and attitudes toward the use of seclusion and restraint among 40 psychiatric-mental health providers.ResultsAttitudes regarding the use of seclusion and restraints, including a greater willingness to acknowledge patients' rights and the emotional impact of seclusion and restraint use significantly improved post-educational intervention. Improvements were also observed in the comprehension of appropriate seclusion and restraint practices and the effects of staffing levels on seclusion and restraint utilization. Hospitalwide seclusion rates decreased by 35%, and restraint rates post-educational intervention decreased by 58%.ConclusionThis pilot evaluation study demonstrated that targeted education significantly improved attitudes and practices related to seclusion and restraint among psychiatric-mental health nurses and providers. Mean attitude scores increased from 32.7 to 36.8 post-intervention (p = .002), and mean practice scores improved from 33.9 to 35.2 post-intervention (p = .004). The decrease in hospitalwide seclusion and restraint rates post-intervention indicates the intervention could be effective for reducing the reliance on restrictive interventions.

Objective: Health care workers are sustaining significant numbers of workplace violence events, and health care organizations are called to respond. Through critical evaluation, comprehensive planning, and thoughtful steps into action, organizational leaders and direct care staff must work collaboratively to meet the demands of the dynamic health care landscape. Our objective is to identify multidisciplinary, evidence-based practice strategies through the use of tools, innovation, and education to equip health care teams in building a culture of personal and organizational safety.

Methods: A subject-focused review of international research, government, professional, and regulatory guidelines dated 2015 to 2024 was used to identify evidence-based practices and current barriers in workplace violence mitigation. The global nature of workplace violence suggests a need to explore human-centric solutions, and a multidisciplinary framework is ideal to examine the current climate, identify gaps in education and practice, and explore the impact of environmental conditions contributing to workplace violence. Through layered primary, secondary, and tertiary violence prevention strategies, health care systems may engage in continuous quality improvement, elevate interpersonal safety, and mitigate risks associated with workplace violence.

Results: Deepening conversations and establishing multi-team engagement around workplace violence expands an organization's capacity to break work silos and build processes that can effectively activate organizational change.

Conclusions: With amplified attention to workplace violence, organizations must be committed to addressing the problem from all sides. Through identifying risk factors and mitigation strategies, targeting education, and empowering health care teams, organizations can navigate a strong path toward a safer future for patients, staff, and communities.