The Violence Prevention Community Meeting: A Multi-Site Study.

OBJECTIVE: The Violence Prevention Community Meeting (VPCM) is a specialized form of community meeting in which avoiding violence and promoting non-violent problem solving and interpersonal civility are focal points. A nationwide study to assess the VPCM as an effective intervention to reduce workplace violence was undertaken. PARTICIPANTS: Seven acute locked psychiatric units of the Veterans Health Administration (VHA) throughout the United States participated in the study. METHODS: All patients and all staff on the seven in-patient locked psychiatry units participated in the intervention (VPCM) or as a control (treatment as usual). The study was 21weeks at each site. The three time periods were pre-treatment weeks 1-3, treatment weeks 4-18, and post-treatment weeks 19-21. The VPCM was conducted during the treatment weeks. RESULTS: Overall rates of aggression declined by 0.6% (95% CI: -5.6%, 6.5%; nonsignificant) per week in the intervention hospitals and by 5.1% (95% CI: 0.4%, 9.6%; significant) per week for the control hospitals. CONCLUSIONS: Aggression decreased for both the intervention and control hospitals which could be due to enrollment in a research study and thus being more aware of their ability to address workplace violence at their site.

Incidence and risk factors of workplace violence on psychiatric staff.

BACKGROUND: A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. OBJECTIVE: An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. PARTICIPANTS: Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. METHODS: Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. RESULTS: Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm - 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am - 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. CONCLUSION: Healthcare workers in psychiatric settings are at high risk for aggression from patients.

Reducing violence against nurses: the violence prevention community meeting.

Research was undertaken to validate the efficacy of a new, nurse-led treatment, the Violence Prevention Community Meeting (VPCM), for reducing patient violence on an acute-care inpatient psychiatry unit. Nursing staff members carried event counters and recorded verbal and physical violence as it occurred over the 20-week study. Significant decreases in patient violence were found across day, evening, and night shifts for pre-treatment vs. treatment and pre-treatment vs. post-treatment comparisons. For the day shift, when twice-weekly VPCM treatment took place, violent incidents decreased 89% from pre-treatment to treatment and 57% from pre-treatment to post-treatment.

Multiple perspectives on assault: the 360-degree interview.

Workplace violence is common in health care settings. The authors review various models of this violence that have developed over time. From a linear model, understanding progressed to an interactional and then to a contextual model of assault that examines interactions of the aggressor, victim, and the environment. To date, there has not been a satisfactory research methodology to explore the complexities of the contextual model. This article proposes the 360-degree evaluation as an appropriate methodology for examination of multiple perspectives on assault. The 360-degree model allows comparison of perspectives of the assailant, victim, victim's peers, and victim's supervisor. J Am Psychiatr Nurses Assoc, 2009; 14(6), 413-420.

Non-physical violence: a risk factor for physical violence in health care settings.

This research study assessed the extent to which non-physical violence is a risk factor for physical violence against workers in health care settings. More than 600 nursing staff, other clinical providers, and non-clinical staff in two health care settings completed a cross-sectional survey. For the preceding 12-month period, 72.8% of workers reported at least one incident of non-physical violence and 21.3% reported at least one incident of physical violence. Workers who had experienced non-physical violence were 7.17 times more likely to experience physical violence than those who had not. Both patients and employees were perpetrators of non-physical and physical violence. These results indicate efforts to prevent or reduce physical violence against health care workers need to focus on non-physical as well as physical violence and employee as well as patient perpetrators.

Violence against psychiatric nurses: sensitive research as science and intervention.

Psychiatric nurses are frequent victims of workplace violence, much of which is perpetrated by patients. In a review of literature on prevalence, perpetrators, and impact of violence on psychiatric nurses, we note that workplace violence is a virtually normative experience for the nurse, rather than a rare occurrence. Verbal violence and sexual harassment, like physical violence, are common experiences; in contrast to physical violence, these are often initiated by co-workers. The emotional impact of violence on psychiatric nurses is studied less often than frequency of exposure; we discuss hypotheses for this paucity of relevant research. Finally, we reflect on the implications of current research, concluding with recommendations for future research on violence against psychiatric nurses. In particular, we elaborate on the role of violence research in the healthcare setting as "sensitive research"--a research process that in itself may have both direct and indirect beneficial effects for the nursing profession.