Accepted Manuscript A Workplace Violence Educational Program: A Repeated Measures Study Gordon Lee Gillespie , PhD, PHCNS-BC, FAEN Sharon Lee Farra , PhD, RN Donna M. Gates , EdD, RN, FAAN PII:
S1471-5953(14)00049-3
DOI:
10.1016/j.nepr.2014.04.003
Reference:
YNEPR 1870
To appear in:
Nurse Education in Practice
Received Date: 17 May 2013 Revised Date:
13 January 2014
Accepted Date: 30 April 2014
Please cite this article as: Gillespie, G.L., Farra, S.L., Gates, D.M., A Workplace Violence Educational Program: A Repeated Measures Study, Nurse Education in Practice (2014), doi: 10.1016/ j.nepr.2014.04.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Title:
A WORKPLACE VIOLENCE EDUCATIONAL PROGRAM: A REPEATED MEASURES STUDY
Word count: 2,755 (3,498 with references) Gordon Lee Gillespie, PhD, PHCNS-BC, FAEN (corresponding author) Assistant Professor & Robert Wood Johnson Foundation Nurse Faculty Scholar College of Nursing University of Cincinnati P.O. Box 210038 Cincinnati, OH 45221-0038 P: +1 (513) 558.5236 E: [email protected]
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Sharon Lee Farra, PhD, RN Assistant Professor Department of Nursing Wright State University University Hall 160 3640 Colonel Glenn Hwy Dayton, OH 45435 P: +1 (937) 775.2519 E: [email protected]
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Authors:
hybrid education; intervention; online learning; tabletop; web-based survey
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Key words:
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Donna M. Gates, EdD, RN, FAAN Professor Emerita College of Nursing University of Cincinnati P.O. Box 210038 Cincinnati, OH 45221-0038 P: +1 (513) 558.5500 E: [email protected]
Funding:
This study was funded by the Dean’s Teaching/Learning Project Award (University of Cincinnati College of Nursing). Dr. Gillespie’s time for analyzing the data and writing the manuscript was supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars program. The funding sources had no role in the study procedures or approval of the study findings.
Conflict:
The authors declare that they have no competing interests.
Contribution: The authors provided the following contributions to this manuscript submission—
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Dr. Gillespie was responsible for all aspects of the study including study conception and design, human subjects protections, execution of the study, analysis and interpretation of data, and preparation and revision of the manuscript.
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Dr. Farra was responsible for study conception and design, execution of the study, analysis and interpretation of data, and preparation and revision of the manuscript.
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Dr. Gates was responsible for study conception and design, interpretation of data, and preparation and revision of the manuscript.
ACCEPTED MANUSCRIPT 1 ABSTRACT Violence against healthcare employees is a profound problem in the emergency department worldwide. One strategy to reduce the risk of violence is prevention focused education. The
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purpose of this paper was to report the learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees. A quasiexperimental design was used to determine the knowledge retention of program content
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following a hybrid (online and classroom) educational intervention. One hundred twenty
emergency department employees that completed the workplace violence prevention program
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participated in the study. A repeated-measures analysis of variance was conducted to determine if individual test scores increased significantly between baseline, posttest, and six month posttest periods. The results indicated a significant time effect, Wilk’s Λ = .390, F(2,118) = 26.554, p < .001, η2 = .310. Follow-up polynomial contrasts indicated a significant linear effect with means
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increasing over time, F(1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly higher over time. It was concluded that the use of a hybrid modality
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increases the probability that significant learning outcomes and retention will be achieved.
ACCEPTED MANUSCRIPT 2 INTRODUCTION Violence against healthcare employees is a profound problem in the emergency department setting worldwide (Albashtawy 2013; Estryn-Behar et al 2008; International Labour
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Organization, International Council of Nurses, World Health Organization, & Public Services International, 2002; Knowles et al 2013). Kowalenko et al (2013) reported that on average an emergency department employee will experience 4.017 physical threats and 1.510 assaults per
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year. A primary prevention strategy, often recommended for preventing workplace violence (i.e., verbal abuse, threats, and assaults) from patients and visitors, is educational programming
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(Beech 2008; Gates et al 2011a; Gates et al 2011b; Gillespie et al 2010; Hardin 2012; Kowalenko et al 2012; Nau et al 2009). Before violence education becomes the mainstay of a comprehensive violence management program, it is important to determine if employees' knowledge increases from the educational content. The purpose of this paper was to report the
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learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees.
BACKGROUND
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The authors found few descriptions of workplace violence educational programs in the peer-reviewed literature. Two exemplars of workplace violence educational programs were
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presented by Hartley et al (2012) and Gillespie et al (2012). The following paragraphs provide a brief overview of each program. Hartley et al (2012) detailed an online violence program designed for healthcare employees. The program was described as a “mix of text, videos, and graphics to create an interactive learning experience” (Hartley et al 2012, p.203). Because the authors did not provide program evaluation data for their program it was not possible to determine the degree to which employees learned the program content.
ACCEPTED MANUSCRIPT 3 Gillespie et al (2012) conducted a quasi-experimental study comparing two educational treatment strategies: (1) online content and (2) online and classroom-based content. The researchers found that both groups had a significant increase in their learning of the violence
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program content. It was not reported if the emergency department employees were able to retain the new knowledge over time.
There remains few reported workplace violence programs in the literature (Kynoch et al
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2011). The programs available provided evidence that short term knowledge attainment occurs (Kynoch et al 2011); however, there was a gap pertaining to the long term retention of violence
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program education. It was therefore important to determine if workplace violence program content could be maintained for a longer period of time (e.g., six months). If emergency department employees are not able to retain program content for extended periods of time, program content is not likely to affect a significant reduction in an incidence rate for workplace
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violence. This paper begins to fill the scientific gap by reporting the knowledge attainment (immediate posttest) and retention (six month posttest) of a workplace violence educational program delivered to emergency department employees.
Design
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METHODS
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A quasi-experimental design was used to determine the knowledge retention of program
content following a hybrid educational intervention. The hybrid modality included both online and classroom components. The researchers hypothesized that there would be a significant increase in learning retention for employees who completed the hybrid educational intervention as measured by program test scores. Institutional Review Board approval was granted from the [removed for anonymity] and the two partnering hospital organizations.
ACCEPTED MANUSCRIPT 4 Setting and sample Participants were recruited from the emergency departments of two separate healthcare systems in the Midwest United States. One system was a pediatric specialty system with two
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emergency departments, one community based and the other a Level 1 pediatric trauma center. The other system was a university-affiliated, teaching system with a Level 1 adult/pediatric trauma center and emergency department.
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The only inclusion criterion was that participants complete all components of the hybrid education offered to the employees during summer 2011. Eligible participants were nurses,
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social workers, child life specialists, and unlicensed assistive personnel (see Figure 1 for attrition information). Completing the hybrid education was a requirement of the pediatric health system’s new workplace violence policy and not specific to this study. Approximately 83% (n=197) of 238 employees from the two pediatric emergency departments completed the
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training. Completing the hybrid education at the adult/pediatric system was required for members of the emergency department’s core workplace violence team and optional for all other employees. Approximately 19% (n=30) of 156 employees from the adult/pediatric emergency
Power analysis
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department participated.
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A post hoc power calculation was determined using G*Power 3.0 (Faul et al 2007).
Given effect size .310, α = .05, sample size 120, and three measurements per participant, our study yielded sufficient power (> 95%) to conduct the planned data analyses. Workplace violence program Employees received a revised iteration of a hybrid educational program with online and classroom components designed to inform emergency department employees about workplace
ACCEPTED MANUSCRIPT 5 violence by patients and visitors. The first component included three asynchronous online modules completed during June and July 2011. Module 1 focused on workplace violence prevention and included topics such as environmental safety, risk assessment, and
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communicating effectively with patients and visitors. Module 2 focused on safely managing workplace violence through a coordinated team approach. Module 3 focused on the post-incident response and included topics such as incident reporting and caring for victimized workers. Prior
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to starting Module 1, employees were prompted to complete a 20 question pretest on workplace violence. After completing Module 3, employees were prompted to complete a 20 question
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posttest on workplace violence. Questions were identical for the pretest and posttest. The answers were not given to participants. Employees were able to complete the training over multiple sittings with the program resuming where the employee last left the training. The second component was an interactive two-hour classroom-based tabletop exercise
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during August/September 2011. For this component, employees watched a series of video vignettes depicting patient and visitor violence in the emergency department. This component prompted employees to discuss, apply, and collaborate with their interprofessional colleagues on
Instrumentation
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how to best manage the incident of workplace violence depicted in each video vignette.
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The study instrument was a 20 question workplace violence test plus short demographic
questionnaire. The test questions were developed to measure knowledge in preventing, managing, and reporting incidents of workplace violence. Test development consisted of initial item development by violence and education experts. The items were then reviewed by a panel of violence experts and revised based on their feedback. Questions were leveled to test
ACCEPTED MANUSCRIPT 6 participants at multiple levels within Bloom’s taxonomy of educational objectives (Bloom et al 1956). Examples of test questions are presented in Table 1. Procedures
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During May 2011, all employees from the partnering emergency departments were
administratively enrolled into a learning management system (LMS) for the workplace violence educational program using the fields of first name, last name, occupation, study site, and
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employee email address. Information for the demographic fields was provided by the emergency department administrators after securing Institutional Review Board approvals.
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Beginning June 1, 2011, notifications that the LMS was ready for employees to complete the training were initiated by the emergency department educators and automated from the LMS. Educators were provided weekly Microsoft Access database reports of employee progression for the online training. The LMS closed on July 31, 2011.
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Next, employees signed up for a classroom-based tabletop exercise. Dates and times of the sessions were determined by the emergency department educators and were scheduled to accommodate day shift, evening shift, and night shift employees. All sessions were led by the
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study’s principal investigator and/or two trained department educators for consistency in program delivery. Weekly Microsoft Access (Redmond, WA) database reports were emailed to
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the emergency department educators to monitor employees’ progression. From November 2011 to February 2012, the sample was recruited and signed informed
consent documentation for study participation. Study consent included a provision to allow the pretest and posttest data completed during their workplace violence training to be used as research data for analysis in this study.
ACCEPTED MANUSCRIPT 7 Enrolled participants were emailed a link to complete a 6-month posttest during March 2012. The email and posttest link were automated from the LMS and were distributed weekly for three weeks. Twenty participants did not access the 6-month posttest and three participants
data from participants who withdrew were not used in the analyses.
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started, but did not finish the 6-month posttest indicating their withdrawal from the study. The
After data collection was closed, the pretest (Time 1), posttest (Time 2), and 6-month
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posttest (Time 3) data were extracted from the LMS and imported into IBM SPSS Statistics 21 (Armonk, NY). All identifiers (i.e., first name, last name, email address) were removed from the
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database leaving only non-identifiable demographic variables in the database prior to analysis. Data analysis
The study sample was described with means and ranges for interval data and frequencies and percentages for nominal and ordinal data. Test scores for Time 1, Time 2, and Time 3 were
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reported as means. A repeated-measures analysis of variance (ANOVA) using the Wilk’s Λ statistic was conducted to determine if individual test scores changed significantly between Time 1, Time 2, and Time 3. The Wilk’s Λ statistic is used to assess changes within subjects with a
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repeated measures study design. Alpha was set at .05. RESULTS
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One hundred twenty employees completed the study procedures. The majority was
female (n=104, 86.7%), white (n=112, 93.3%), and a registered nurse (n=86, 71.7%). See Table 2 for additional demographic data. The mean test score at Time 1 was 58.5% (range 25-85%), Time 2 was 61.8% (range 25-85%), and Time 3 was 66.8% (range 40-90%). See Figure 2 for the boxplot distributions of test scores.
ACCEPTED MANUSCRIPT 8 A repeated-measures ANOVA was used to measure the within-subjects’ effects. The factor measured was time of test measurement (Time 1, Time 2, and Time 3) with the dependent variable being workplace violence test scores. The results for the repeated measures ANOVA
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indicated a significant time effect, Wilk’s Λ = .390, F(2,118) = 26.554, p < .001, η2 = .310.
Follow-up polynomial contrasts indicated a significant linear effect with means increasing over
higher over time. DISCUSSION
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time, F(1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly
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Finding a significant increase in knowledge post completion of the online modules was an expected result. A similar finding was reported by Gillespie et al (2012) following the completion of the original version of this violence program using a sample from hospitals not affiliated with the health systems of the current sample. Given appropriate content and
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presentation, an increase in knowledge was anticipated following an online educational experience. There is a large body of evidence to support positive learning outcomes when active learning strategies (e.g., tabletop exercise) were used. A recent meta-analysis, commissioned by
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the U.S. Department of Education, examined rigorous research in online learning and found that students in online courses tended to perform equal to those in traditional face-to-face classes
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(Means et al 2010).
An important finding of this research is the significant increase in learning (test scores) at
six months following completion of the tabletop exercise when knowledge retention may be anticipated to falter. Means et al (2010) found in their meta-analysis that students in hybrid or blended modalities (combined online and face-to-face) had superior learning outcomes to those in the classroom alone. So while online learning appears to be equal to, but not superior to
ACCEPTED MANUSCRIPT 9 conventional classroom instruction (statistically equivalent), hybrid approaches may be superior (mean effect size +0.35, p < .001) to solely classroom instruction. The authors suggested that additional learning materials and the opportunities for collaboration may result in the observed
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learning advantages (Means et al 2010). This assertion was supported by the research of Castle and McQuire (2010) who examined 4,038 course assessment summaries for students' selfreported learning. Findings from the study suggest that along with content and instructor
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competence, those modalities providing the highest degree of learner interaction foster the greatest learning. [Removed for anonymity] reported qualitative findings using the same
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population as the current study that there was a high degree of facilitated engagement between the instructors and employee learners during the tabletop exercise sessions. The use of the tabletop exercise following the online modules was designed to foster high degrees of interaction and cooperation among the participants and the course facilitators.
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Collaborative learning, a key active learning strategy in our program, is an intellectual undertaking where participants work cooperatively to become educated on a particular subject (Koehn 2001). The Institute of Medicine Report (Committee on the Robert Wood Johnson
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Foundation Initiative on the Future of Nursing 2011) on the future of nursing described the importance of preparing nurses to work collaboratively and effectively with other health
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professionals within the healthcare system. Collaborative learning can benefit participants academically, socially, and psychologically (Kinyon et al 2009; Panitz 1999). Outcomes of collaborative learning include enhancement of learning and critical thinking skills (Feingold et al 2008; Panitz 1999). As a result of this collaborative experience, learners in the violence program may have been able to retain their knowledge long term in the context of how interprofessional colleagues must interact to prevent and manage workplace violence. This collaborative
ACCEPTED MANUSCRIPT 10 experience also may have accounted for the significant increase in the test scores following the tabletop exercise. Other components of the workplace violence course likely positively affected learning.
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Reporting on how people learn, the National Research Council (2000) described the movement from memorization to understanding as the ability to transfer knowledge to situations. Critical to transfer were motivation, contextual meaning, and active learning strategies. Motivation was
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linked to the usefulness of information learned (National Research Council 2000). Participants in the workplace violence program were taught information that was directly applicable to their
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work environment. The tabletop exercise provided contextual meaning by using video case studies that were both realistic and applicable to the environment in which the acquired knowledge would be applied (Gillespie et al 2012). Active learning was achieved through collaboration in responding to the unfolding case study thus improving the potential transfer of
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the information from the online modules (Gillespie et al 2012). The use of these strategies promoted learning and potential transfer with enhanced learning retention. Another critical component of the learning and retention process is initial learning. The
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National Research Council (2000) described initial learning as the presentation of the foundational materials which form the basis of the new knowledge. The successful transfer of
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learning is dependent upon the degree of mastery of the original subject. Without an adequate level of initial learning, transfer cannot be expected. The modules offered the initial basis for learning that was built upon by the discussion during the tabletop exercise. Using the online modules as preparation for the tabletop exercise allowed class time to be spent on application and synthesis of collaborative activities.
ACCEPTED MANUSCRIPT 11 The amount of time on task was also critical for learning. Students needed both time to learn and time to process information. Learning cannot be rushed; information integration is a complex activity requiring sufficient time (National Research Council 2000). The sequential
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completion of the online modules and the tabletop exercise over a three to four month time
period allowed for both initial learning and transfer. The sequential and prolonged engagement with the content allowed learners to build upon knowledge gained in each activity ([removed for
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anonymity]). Cooper (1998) recommended “chunking” of information where information is presented in smaller units to decrease cognitive load, because working (short term) memory is
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limited and long-term memory is unlimited. For this purpose, the online program modules were presented as 15 shorter units. By providing the content within each module as short presentations and allowing learners several weeks to complete the online learning, learners were more likely to store program content in their long-term memory. Using both strategies resulted in knowledge
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gains, but the greatest increase to both learning and retention occurred following the tabletop exercise reflecting the complementarity of the active learning strategies used in our program. CONCLUSION
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The use of hybrid modalities increases the probability that learning outcomes will be achieved. Online learning alone is effective in obtaining some learning outcomes, but to have
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significant learning and retention hybrid methods are needed. Implications for both educators involved in the education of new nurses and members of staff development are twofold. Students need to be prepared for learning: initial presentation of materials by reading, completing online modules, listening to podcasts, et cetera is essential. Highest levels of retention are obtained when initial learning builds upon and is reinforced by collaborative and active learning strategies where opportunities to apply and synthesize concepts is used. Future research is needed to
ACCEPTED MANUSCRIPT 12 determine if the synergistic effect of our hybrid program can be replicated with additional
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populations and with other hybrid programs.
ACCEPTED MANUSCRIPT 13 REFERENCES Albashtawy, M., 2013. Workplace violence against nurses in emergency departments in Jordan. International Nursing Review 60, 550–555.
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Beech, B, 2008. Aggression prevention training for student nurses: Differential responses to training and the interaction between theory and practice. Nurse Education in Practice 8, 94-102. doi:10.1016/j.nepr.2007.04.004
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Bloom, B., Englehart, M., Furst, E., Hill, W., Krathwohl, D., 1956. Taxonomy of Educational Objectives: The Classification of Educational Goals. Handbook I: Cognitive domain.
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Longmans Green, New York City, NY.
Castle, S. R., McQuire, C., 2010. An analysis of student self-assessment of online, blended, and face-to-face learning environments: Implications for sustainable education delivery. International Education Studies 3 (3), 36-40.
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Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, 2011. The future of nursing: Leading change, advancing health. The National Academies Press, Washington, DC.
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Cooper, G., 1998. Research into cognitive load theory and instructional design at UNSW. University of New South Wales, Sydney, Australia. Retrieved from
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http://dwb4.unl.edu/Diss/Cooper/UNSW.htm
Estryn-Behar, M., van der Heijden, B., Camerino, D., Fry, C., Le Nezet, O., Conway, P. M., Hasselhorn, H., 2008. Violence risks in nursing—results from the European ‘NEXT’ Study. Occupational Medicine 58, 107-114. doi:10.1093/occmed/kqm142
ACCEPTED MANUSCRIPT 14 Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A., 2007. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 39, 175-191.
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Feingold, C. E., Cobb, M. D., Givens, R. H., Arnold, J., Joslin, S., Keller, J. L., 2008. Student perceptions of team learning in nursing education. Journal of Nursing Education 47 (5), 214-222.
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Gates, D., Gillespie, G., Smith, C., Rode, J., Kowalenko, T., Smith, B., 2011. Using action research to plan a violence prevention program for emergency departments. Journal of
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Emergency Nursing 37 (1), 32-39. doi: 10.1016/j.jen.2009.09.013
Gates, D. M., Gillespie, G. L., Succop, P., 2011. Violence against nurses and its impact on stress and productivity. Journal of Nursing Economic$ 29 (2), 59-66. Gillespie, G. L., Gates, D. M., Mentzel, T., 2012. An educational program to prevent, manage,
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and recover from workplace violence. Advanced Emergency Nursing Journal 34 (4), 325332. doi: 10.1097/TME.0b013e318267b8a9 Gillespie, G. L., Gates, D. M., Miller, M., Howard, P. K., 2010. Violence against healthcare
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workers in a pediatric emergency department. Advanced Emergency Nursing Journal 32 (1), 68-82. doi: 10.1097/TME.0b013e3181c8b0b4
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Hardin, D., 2012. Strategies for nurse leaders to address aggressive and violent events. Journal of Nursing Administration 4 (1), 5-8. doi: 10.1097/NNA.0b013e31823c16e1
Hartley, D., Ridenour, M., Craine, J., Costa, B., 2012. Workplace violence prevention for healthcare workers—An online course. Rehabilitation Nursing 37 (4), 202-206.
ACCEPTED MANUSCRIPT 15 International Labour Organization, International Council of Nurses, World Health Organization, & Public Services International, 2002. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva, Switzerland.
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Kinyon, J., Keith, C. B., Pistole, M. C., 2009. A collaborative approach to group experiential learning with undergraduate nursing students. Journal of Nursing Education 48 (3), 165166.
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Knowles, E., Mason, S. M., Moriarty, F., 2013. ‘I’m going to learn how to run quick’: exploring violence directed towards staff in the emergency department. Emergency Medicine
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Journal 30, 926-931. doi:10.1136/emermed-2012-201329
Koehn, E., 2001. Assessment of communications and collaborative learning in civil engineering education. Journal of Professional Issues in Engineering Education and Practice 127 (4), 160-165.
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Kowalenko, T., Gates, D., Gillespie, G. L., Succop, P., Mentzel, T. K., 2013. Prospective study of violence against ED workers. American Journal of Emergency Medicine 31 (1), 197205. doi: 10.1016/j.ajem.2012.07.010
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Kowalenko, T., Cunningham, R., Sachs, C. J., Gore, R., Barata, I. A., Gates, D., . . . McClain, A., 2012. Workplace violence in emergency medicine: Current knowledge and future
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directions. The Journal of Emergency Medicine 43 (3), 523-531. doi: 10.1016/j.jemermed.2012.02.056
Kynoch, K., Wu, C.-J., Chang, A. M., 2011. Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: A systematic review. Worldviews on Evidence-based Nursing 8 (2), 76-86. doi: 10.1111/j.17416787.2010.00206.x
ACCEPTED MANUSCRIPT 16 Means, B., Toyama, Y., Murphy, R., Bakia, M., Jones, K., 2010. Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. United States Department of Education Office of Planning, Evaluation, and Policy
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Development Policy and Program Studies Service, Washington, DC.
National Research Council, 2000. How people learn: Brain, mind, experience, and school: Expanded edition. The National Academies Press, Washington, DC.
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Nau, J., Dassen, T., Needham, I., Halfens, R., 2009. The development and testing of a training course in aggression for nursing students: A pre- and post-test study. Nurse Education
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Today 29, 196-207. doi:10.1016/j.nedt.2008.08.011
Panitz, T., 1999. The case for student centered instruction via collaborative learning paradigms. Retrieved from
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http://studentcenteredlearning.pbworks.com/f/CaseForStudentCenteredLearning.pdf
ACCEPTED MANUSCRIPT 19 Table 1. Sample workplace violence program test questions. Answer options
What is the emergency department worker’s
a. Resolve the situation as quickly as
first priority when dealing with an escalating patient?
possible.
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Question
b. Remove the patient from the emergency
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department.
c. Increase your distance from the patient.
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d. Immediately call the police department.
What should the emergency department worker a. Use a firm voice and say, “Call security!” say or do when a patient shows signs of
increasing escalation (e.g., derogatory name
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calling, cursing) and additional help is needed from the coworkers standing nearby?
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The physician informed the mother of a twoyear-old critically ill patient that test results
b. Look at the patient and say, “You will not talk to me like that.”
c. Document the event in the medical record d. Use a hand gesture to indicate help is needed
a. Evict the mother from the emergency department b. Tell your coworkers about the violent event
mother becomes verbally and physically
c. Complete an incident/safety event report
violent. After the violence has stops, what
d. Expedite the patient’s admission to the
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indicate the patient may have cancer. The
intervention should be performed first?
pediatric ICU
ACCEPTED MANUSCRIPT 20 Table 2. Demographic characteristics of the study sample (n=120).
Female
104
Male
16
White
112
Black/Other
8
13.3%
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Race
86.7%
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Sex
%
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N
Ethnicity Hispanic
93.3% 6.7%
2
1.8%
110
98.2%
1
0.8%
16
13.3%
26
21.7%
Bachelor’s degree
69
57.5%
Master’s degree
8
6.7%
Day shift
49
40.8%
Evening shift
35
29.2%
Night shift
26
21.7%
Variable shift
10
8.3%
Non-Hispanic
High school Some college
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Associate degree
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Educational attainment
Primary work shift
ACCEPTED MANUSCRIPT 21 Occupation 86
71.7%
Respiratory therapist
6
5%
Child life specialist
2
1.7%
Paramedic
14
Patient care assistant
12
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Registered nurse
11.7%
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10%
ACCEPTED MANUSCRIPT 22 Table 3. Standard
Paired difference
Paired difference
deviation
(T2-Tn)
(T3-Tn) 8.250
Time 1 (T1)
58.5
10.6
3.208
Time 2 (T2)
61.8
10.1
-
Time 3 (T3)
66.8
9.3
-5.042
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Mean
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5.042 -
ACCEPTED MANUSCRIPT 17
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Figure 1. Attrition chart.
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Figure 2. Boxplot distributions displaying participant test scores.
S1471-5953(14)00049-3
DOI:
10.1016/j.nepr.2014.04.003
Reference:
YNEPR 1870
To appear in:
Nurse Education in Practice
Received Date: 17 May 2013 Revised Date:
13 January 2014
Accepted Date: 30 April 2014
Please cite this article as: Gillespie, G.L., Farra, S.L., Gates, D.M., A Workplace Violence Educational Program: A Repeated Measures Study, Nurse Education in Practice (2014), doi: 10.1016/ j.nepr.2014.04.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title:
A WORKPLACE VIOLENCE EDUCATIONAL PROGRAM: A REPEATED MEASURES STUDY
Word count: 2,755 (3,498 with references) Gordon Lee Gillespie, PhD, PHCNS-BC, FAEN (corresponding author) Assistant Professor & Robert Wood Johnson Foundation Nurse Faculty Scholar College of Nursing University of Cincinnati P.O. Box 210038 Cincinnati, OH 45221-0038 P: +1 (513) 558.5236 E: [email protected]
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Sharon Lee Farra, PhD, RN Assistant Professor Department of Nursing Wright State University University Hall 160 3640 Colonel Glenn Hwy Dayton, OH 45435 P: +1 (937) 775.2519 E: [email protected]
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Authors:
hybrid education; intervention; online learning; tabletop; web-based survey
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Key words:
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Donna M. Gates, EdD, RN, FAAN Professor Emerita College of Nursing University of Cincinnati P.O. Box 210038 Cincinnati, OH 45221-0038 P: +1 (513) 558.5500 E: [email protected]
Funding:
This study was funded by the Dean’s Teaching/Learning Project Award (University of Cincinnati College of Nursing). Dr. Gillespie’s time for analyzing the data and writing the manuscript was supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars program. The funding sources had no role in the study procedures or approval of the study findings.
Conflict:
The authors declare that they have no competing interests.
Contribution: The authors provided the following contributions to this manuscript submission—
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Dr. Gillespie was responsible for all aspects of the study including study conception and design, human subjects protections, execution of the study, analysis and interpretation of data, and preparation and revision of the manuscript.
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Dr. Farra was responsible for study conception and design, execution of the study, analysis and interpretation of data, and preparation and revision of the manuscript.
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Dr. Gates was responsible for study conception and design, interpretation of data, and preparation and revision of the manuscript.
ACCEPTED MANUSCRIPT 1 ABSTRACT Violence against healthcare employees is a profound problem in the emergency department worldwide. One strategy to reduce the risk of violence is prevention focused education. The
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purpose of this paper was to report the learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees. A quasiexperimental design was used to determine the knowledge retention of program content
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following a hybrid (online and classroom) educational intervention. One hundred twenty
emergency department employees that completed the workplace violence prevention program
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participated in the study. A repeated-measures analysis of variance was conducted to determine if individual test scores increased significantly between baseline, posttest, and six month posttest periods. The results indicated a significant time effect, Wilk’s Λ = .390, F(2,118) = 26.554, p < .001, η2 = .310. Follow-up polynomial contrasts indicated a significant linear effect with means
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increasing over time, F(1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly higher over time. It was concluded that the use of a hybrid modality
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increases the probability that significant learning outcomes and retention will be achieved.
ACCEPTED MANUSCRIPT 2 INTRODUCTION Violence against healthcare employees is a profound problem in the emergency department setting worldwide (Albashtawy 2013; Estryn-Behar et al 2008; International Labour
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Organization, International Council of Nurses, World Health Organization, & Public Services International, 2002; Knowles et al 2013). Kowalenko et al (2013) reported that on average an emergency department employee will experience 4.017 physical threats and 1.510 assaults per
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year. A primary prevention strategy, often recommended for preventing workplace violence (i.e., verbal abuse, threats, and assaults) from patients and visitors, is educational programming
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(Beech 2008; Gates et al 2011a; Gates et al 2011b; Gillespie et al 2010; Hardin 2012; Kowalenko et al 2012; Nau et al 2009). Before violence education becomes the mainstay of a comprehensive violence management program, it is important to determine if employees' knowledge increases from the educational content. The purpose of this paper was to report the
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learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees.
BACKGROUND
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The authors found few descriptions of workplace violence educational programs in the peer-reviewed literature. Two exemplars of workplace violence educational programs were
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presented by Hartley et al (2012) and Gillespie et al (2012). The following paragraphs provide a brief overview of each program. Hartley et al (2012) detailed an online violence program designed for healthcare employees. The program was described as a “mix of text, videos, and graphics to create an interactive learning experience” (Hartley et al 2012, p.203). Because the authors did not provide program evaluation data for their program it was not possible to determine the degree to which employees learned the program content.
ACCEPTED MANUSCRIPT 3 Gillespie et al (2012) conducted a quasi-experimental study comparing two educational treatment strategies: (1) online content and (2) online and classroom-based content. The researchers found that both groups had a significant increase in their learning of the violence
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program content. It was not reported if the emergency department employees were able to retain the new knowledge over time.
There remains few reported workplace violence programs in the literature (Kynoch et al
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2011). The programs available provided evidence that short term knowledge attainment occurs (Kynoch et al 2011); however, there was a gap pertaining to the long term retention of violence
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program education. It was therefore important to determine if workplace violence program content could be maintained for a longer period of time (e.g., six months). If emergency department employees are not able to retain program content for extended periods of time, program content is not likely to affect a significant reduction in an incidence rate for workplace
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violence. This paper begins to fill the scientific gap by reporting the knowledge attainment (immediate posttest) and retention (six month posttest) of a workplace violence educational program delivered to emergency department employees.
Design
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METHODS
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A quasi-experimental design was used to determine the knowledge retention of program
content following a hybrid educational intervention. The hybrid modality included both online and classroom components. The researchers hypothesized that there would be a significant increase in learning retention for employees who completed the hybrid educational intervention as measured by program test scores. Institutional Review Board approval was granted from the [removed for anonymity] and the two partnering hospital organizations.
ACCEPTED MANUSCRIPT 4 Setting and sample Participants were recruited from the emergency departments of two separate healthcare systems in the Midwest United States. One system was a pediatric specialty system with two
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emergency departments, one community based and the other a Level 1 pediatric trauma center. The other system was a university-affiliated, teaching system with a Level 1 adult/pediatric trauma center and emergency department.
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The only inclusion criterion was that participants complete all components of the hybrid education offered to the employees during summer 2011. Eligible participants were nurses,
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social workers, child life specialists, and unlicensed assistive personnel (see Figure 1 for attrition information). Completing the hybrid education was a requirement of the pediatric health system’s new workplace violence policy and not specific to this study. Approximately 83% (n=197) of 238 employees from the two pediatric emergency departments completed the
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training. Completing the hybrid education at the adult/pediatric system was required for members of the emergency department’s core workplace violence team and optional for all other employees. Approximately 19% (n=30) of 156 employees from the adult/pediatric emergency
Power analysis
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department participated.
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A post hoc power calculation was determined using G*Power 3.0 (Faul et al 2007).
Given effect size .310, α = .05, sample size 120, and three measurements per participant, our study yielded sufficient power (> 95%) to conduct the planned data analyses. Workplace violence program Employees received a revised iteration of a hybrid educational program with online and classroom components designed to inform emergency department employees about workplace
ACCEPTED MANUSCRIPT 5 violence by patients and visitors. The first component included three asynchronous online modules completed during June and July 2011. Module 1 focused on workplace violence prevention and included topics such as environmental safety, risk assessment, and
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communicating effectively with patients and visitors. Module 2 focused on safely managing workplace violence through a coordinated team approach. Module 3 focused on the post-incident response and included topics such as incident reporting and caring for victimized workers. Prior
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to starting Module 1, employees were prompted to complete a 20 question pretest on workplace violence. After completing Module 3, employees were prompted to complete a 20 question
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posttest on workplace violence. Questions were identical for the pretest and posttest. The answers were not given to participants. Employees were able to complete the training over multiple sittings with the program resuming where the employee last left the training. The second component was an interactive two-hour classroom-based tabletop exercise
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during August/September 2011. For this component, employees watched a series of video vignettes depicting patient and visitor violence in the emergency department. This component prompted employees to discuss, apply, and collaborate with their interprofessional colleagues on
Instrumentation
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how to best manage the incident of workplace violence depicted in each video vignette.
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The study instrument was a 20 question workplace violence test plus short demographic
questionnaire. The test questions were developed to measure knowledge in preventing, managing, and reporting incidents of workplace violence. Test development consisted of initial item development by violence and education experts. The items were then reviewed by a panel of violence experts and revised based on their feedback. Questions were leveled to test
ACCEPTED MANUSCRIPT 6 participants at multiple levels within Bloom’s taxonomy of educational objectives (Bloom et al 1956). Examples of test questions are presented in Table 1. Procedures
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During May 2011, all employees from the partnering emergency departments were
administratively enrolled into a learning management system (LMS) for the workplace violence educational program using the fields of first name, last name, occupation, study site, and
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employee email address. Information for the demographic fields was provided by the emergency department administrators after securing Institutional Review Board approvals.
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Beginning June 1, 2011, notifications that the LMS was ready for employees to complete the training were initiated by the emergency department educators and automated from the LMS. Educators were provided weekly Microsoft Access database reports of employee progression for the online training. The LMS closed on July 31, 2011.
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Next, employees signed up for a classroom-based tabletop exercise. Dates and times of the sessions were determined by the emergency department educators and were scheduled to accommodate day shift, evening shift, and night shift employees. All sessions were led by the
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study’s principal investigator and/or two trained department educators for consistency in program delivery. Weekly Microsoft Access (Redmond, WA) database reports were emailed to
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the emergency department educators to monitor employees’ progression. From November 2011 to February 2012, the sample was recruited and signed informed
consent documentation for study participation. Study consent included a provision to allow the pretest and posttest data completed during their workplace violence training to be used as research data for analysis in this study.
ACCEPTED MANUSCRIPT 7 Enrolled participants were emailed a link to complete a 6-month posttest during March 2012. The email and posttest link were automated from the LMS and were distributed weekly for three weeks. Twenty participants did not access the 6-month posttest and three participants
data from participants who withdrew were not used in the analyses.
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started, but did not finish the 6-month posttest indicating their withdrawal from the study. The
After data collection was closed, the pretest (Time 1), posttest (Time 2), and 6-month
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posttest (Time 3) data were extracted from the LMS and imported into IBM SPSS Statistics 21 (Armonk, NY). All identifiers (i.e., first name, last name, email address) were removed from the
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database leaving only non-identifiable demographic variables in the database prior to analysis. Data analysis
The study sample was described with means and ranges for interval data and frequencies and percentages for nominal and ordinal data. Test scores for Time 1, Time 2, and Time 3 were
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reported as means. A repeated-measures analysis of variance (ANOVA) using the Wilk’s Λ statistic was conducted to determine if individual test scores changed significantly between Time 1, Time 2, and Time 3. The Wilk’s Λ statistic is used to assess changes within subjects with a
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repeated measures study design. Alpha was set at .05. RESULTS
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One hundred twenty employees completed the study procedures. The majority was
female (n=104, 86.7%), white (n=112, 93.3%), and a registered nurse (n=86, 71.7%). See Table 2 for additional demographic data. The mean test score at Time 1 was 58.5% (range 25-85%), Time 2 was 61.8% (range 25-85%), and Time 3 was 66.8% (range 40-90%). See Figure 2 for the boxplot distributions of test scores.
ACCEPTED MANUSCRIPT 8 A repeated-measures ANOVA was used to measure the within-subjects’ effects. The factor measured was time of test measurement (Time 1, Time 2, and Time 3) with the dependent variable being workplace violence test scores. The results for the repeated measures ANOVA
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indicated a significant time effect, Wilk’s Λ = .390, F(2,118) = 26.554, p < .001, η2 = .310.
Follow-up polynomial contrasts indicated a significant linear effect with means increasing over
higher over time. DISCUSSION
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time, F(1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly
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Finding a significant increase in knowledge post completion of the online modules was an expected result. A similar finding was reported by Gillespie et al (2012) following the completion of the original version of this violence program using a sample from hospitals not affiliated with the health systems of the current sample. Given appropriate content and
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presentation, an increase in knowledge was anticipated following an online educational experience. There is a large body of evidence to support positive learning outcomes when active learning strategies (e.g., tabletop exercise) were used. A recent meta-analysis, commissioned by
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the U.S. Department of Education, examined rigorous research in online learning and found that students in online courses tended to perform equal to those in traditional face-to-face classes
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(Means et al 2010).
An important finding of this research is the significant increase in learning (test scores) at
six months following completion of the tabletop exercise when knowledge retention may be anticipated to falter. Means et al (2010) found in their meta-analysis that students in hybrid or blended modalities (combined online and face-to-face) had superior learning outcomes to those in the classroom alone. So while online learning appears to be equal to, but not superior to
ACCEPTED MANUSCRIPT 9 conventional classroom instruction (statistically equivalent), hybrid approaches may be superior (mean effect size +0.35, p < .001) to solely classroom instruction. The authors suggested that additional learning materials and the opportunities for collaboration may result in the observed
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learning advantages (Means et al 2010). This assertion was supported by the research of Castle and McQuire (2010) who examined 4,038 course assessment summaries for students' selfreported learning. Findings from the study suggest that along with content and instructor
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competence, those modalities providing the highest degree of learner interaction foster the greatest learning. [Removed for anonymity] reported qualitative findings using the same
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population as the current study that there was a high degree of facilitated engagement between the instructors and employee learners during the tabletop exercise sessions. The use of the tabletop exercise following the online modules was designed to foster high degrees of interaction and cooperation among the participants and the course facilitators.
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Collaborative learning, a key active learning strategy in our program, is an intellectual undertaking where participants work cooperatively to become educated on a particular subject (Koehn 2001). The Institute of Medicine Report (Committee on the Robert Wood Johnson
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Foundation Initiative on the Future of Nursing 2011) on the future of nursing described the importance of preparing nurses to work collaboratively and effectively with other health
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professionals within the healthcare system. Collaborative learning can benefit participants academically, socially, and psychologically (Kinyon et al 2009; Panitz 1999). Outcomes of collaborative learning include enhancement of learning and critical thinking skills (Feingold et al 2008; Panitz 1999). As a result of this collaborative experience, learners in the violence program may have been able to retain their knowledge long term in the context of how interprofessional colleagues must interact to prevent and manage workplace violence. This collaborative
ACCEPTED MANUSCRIPT 10 experience also may have accounted for the significant increase in the test scores following the tabletop exercise. Other components of the workplace violence course likely positively affected learning.
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Reporting on how people learn, the National Research Council (2000) described the movement from memorization to understanding as the ability to transfer knowledge to situations. Critical to transfer were motivation, contextual meaning, and active learning strategies. Motivation was
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linked to the usefulness of information learned (National Research Council 2000). Participants in the workplace violence program were taught information that was directly applicable to their
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work environment. The tabletop exercise provided contextual meaning by using video case studies that were both realistic and applicable to the environment in which the acquired knowledge would be applied (Gillespie et al 2012). Active learning was achieved through collaboration in responding to the unfolding case study thus improving the potential transfer of
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the information from the online modules (Gillespie et al 2012). The use of these strategies promoted learning and potential transfer with enhanced learning retention. Another critical component of the learning and retention process is initial learning. The
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National Research Council (2000) described initial learning as the presentation of the foundational materials which form the basis of the new knowledge. The successful transfer of
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learning is dependent upon the degree of mastery of the original subject. Without an adequate level of initial learning, transfer cannot be expected. The modules offered the initial basis for learning that was built upon by the discussion during the tabletop exercise. Using the online modules as preparation for the tabletop exercise allowed class time to be spent on application and synthesis of collaborative activities.
ACCEPTED MANUSCRIPT 11 The amount of time on task was also critical for learning. Students needed both time to learn and time to process information. Learning cannot be rushed; information integration is a complex activity requiring sufficient time (National Research Council 2000). The sequential
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completion of the online modules and the tabletop exercise over a three to four month time
period allowed for both initial learning and transfer. The sequential and prolonged engagement with the content allowed learners to build upon knowledge gained in each activity ([removed for
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anonymity]). Cooper (1998) recommended “chunking” of information where information is presented in smaller units to decrease cognitive load, because working (short term) memory is
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limited and long-term memory is unlimited. For this purpose, the online program modules were presented as 15 shorter units. By providing the content within each module as short presentations and allowing learners several weeks to complete the online learning, learners were more likely to store program content in their long-term memory. Using both strategies resulted in knowledge
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gains, but the greatest increase to both learning and retention occurred following the tabletop exercise reflecting the complementarity of the active learning strategies used in our program. CONCLUSION
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The use of hybrid modalities increases the probability that learning outcomes will be achieved. Online learning alone is effective in obtaining some learning outcomes, but to have
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significant learning and retention hybrid methods are needed. Implications for both educators involved in the education of new nurses and members of staff development are twofold. Students need to be prepared for learning: initial presentation of materials by reading, completing online modules, listening to podcasts, et cetera is essential. Highest levels of retention are obtained when initial learning builds upon and is reinforced by collaborative and active learning strategies where opportunities to apply and synthesize concepts is used. Future research is needed to
ACCEPTED MANUSCRIPT 12 determine if the synergistic effect of our hybrid program can be replicated with additional
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populations and with other hybrid programs.
ACCEPTED MANUSCRIPT 13 REFERENCES Albashtawy, M., 2013. Workplace violence against nurses in emergency departments in Jordan. International Nursing Review 60, 550–555.
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Beech, B, 2008. Aggression prevention training for student nurses: Differential responses to training and the interaction between theory and practice. Nurse Education in Practice 8, 94-102. doi:10.1016/j.nepr.2007.04.004
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Bloom, B., Englehart, M., Furst, E., Hill, W., Krathwohl, D., 1956. Taxonomy of Educational Objectives: The Classification of Educational Goals. Handbook I: Cognitive domain.
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Longmans Green, New York City, NY.
Castle, S. R., McQuire, C., 2010. An analysis of student self-assessment of online, blended, and face-to-face learning environments: Implications for sustainable education delivery. International Education Studies 3 (3), 36-40.
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Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, 2011. The future of nursing: Leading change, advancing health. The National Academies Press, Washington, DC.
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Cooper, G., 1998. Research into cognitive load theory and instructional design at UNSW. University of New South Wales, Sydney, Australia. Retrieved from
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http://dwb4.unl.edu/Diss/Cooper/UNSW.htm
Estryn-Behar, M., van der Heijden, B., Camerino, D., Fry, C., Le Nezet, O., Conway, P. M., Hasselhorn, H., 2008. Violence risks in nursing—results from the European ‘NEXT’ Study. Occupational Medicine 58, 107-114. doi:10.1093/occmed/kqm142
ACCEPTED MANUSCRIPT 14 Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A., 2007. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 39, 175-191.
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Feingold, C. E., Cobb, M. D., Givens, R. H., Arnold, J., Joslin, S., Keller, J. L., 2008. Student perceptions of team learning in nursing education. Journal of Nursing Education 47 (5), 214-222.
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Gates, D., Gillespie, G., Smith, C., Rode, J., Kowalenko, T., Smith, B., 2011. Using action research to plan a violence prevention program for emergency departments. Journal of
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Emergency Nursing 37 (1), 32-39. doi: 10.1016/j.jen.2009.09.013
Gates, D. M., Gillespie, G. L., Succop, P., 2011. Violence against nurses and its impact on stress and productivity. Journal of Nursing Economic$ 29 (2), 59-66. Gillespie, G. L., Gates, D. M., Mentzel, T., 2012. An educational program to prevent, manage,
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and recover from workplace violence. Advanced Emergency Nursing Journal 34 (4), 325332. doi: 10.1097/TME.0b013e318267b8a9 Gillespie, G. L., Gates, D. M., Miller, M., Howard, P. K., 2010. Violence against healthcare
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workers in a pediatric emergency department. Advanced Emergency Nursing Journal 32 (1), 68-82. doi: 10.1097/TME.0b013e3181c8b0b4
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Hardin, D., 2012. Strategies for nurse leaders to address aggressive and violent events. Journal of Nursing Administration 4 (1), 5-8. doi: 10.1097/NNA.0b013e31823c16e1
Hartley, D., Ridenour, M., Craine, J., Costa, B., 2012. Workplace violence prevention for healthcare workers—An online course. Rehabilitation Nursing 37 (4), 202-206.
ACCEPTED MANUSCRIPT 15 International Labour Organization, International Council of Nurses, World Health Organization, & Public Services International, 2002. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva, Switzerland.
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Kinyon, J., Keith, C. B., Pistole, M. C., 2009. A collaborative approach to group experiential learning with undergraduate nursing students. Journal of Nursing Education 48 (3), 165166.
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Knowles, E., Mason, S. M., Moriarty, F., 2013. ‘I’m going to learn how to run quick’: exploring violence directed towards staff in the emergency department. Emergency Medicine
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Journal 30, 926-931. doi:10.1136/emermed-2012-201329
Koehn, E., 2001. Assessment of communications and collaborative learning in civil engineering education. Journal of Professional Issues in Engineering Education and Practice 127 (4), 160-165.
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Kowalenko, T., Gates, D., Gillespie, G. L., Succop, P., Mentzel, T. K., 2013. Prospective study of violence against ED workers. American Journal of Emergency Medicine 31 (1), 197205. doi: 10.1016/j.ajem.2012.07.010
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Kowalenko, T., Cunningham, R., Sachs, C. J., Gore, R., Barata, I. A., Gates, D., . . . McClain, A., 2012. Workplace violence in emergency medicine: Current knowledge and future
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directions. The Journal of Emergency Medicine 43 (3), 523-531. doi: 10.1016/j.jemermed.2012.02.056
Kynoch, K., Wu, C.-J., Chang, A. M., 2011. Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: A systematic review. Worldviews on Evidence-based Nursing 8 (2), 76-86. doi: 10.1111/j.17416787.2010.00206.x
ACCEPTED MANUSCRIPT 16 Means, B., Toyama, Y., Murphy, R., Bakia, M., Jones, K., 2010. Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. United States Department of Education Office of Planning, Evaluation, and Policy
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Development Policy and Program Studies Service, Washington, DC.
National Research Council, 2000. How people learn: Brain, mind, experience, and school: Expanded edition. The National Academies Press, Washington, DC.
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Nau, J., Dassen, T., Needham, I., Halfens, R., 2009. The development and testing of a training course in aggression for nursing students: A pre- and post-test study. Nurse Education
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Today 29, 196-207. doi:10.1016/j.nedt.2008.08.011
Panitz, T., 1999. The case for student centered instruction via collaborative learning paradigms. Retrieved from
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http://studentcenteredlearning.pbworks.com/f/CaseForStudentCenteredLearning.pdf
ACCEPTED MANUSCRIPT 19 Table 1. Sample workplace violence program test questions. Answer options
What is the emergency department worker’s
a. Resolve the situation as quickly as
first priority when dealing with an escalating patient?
possible.
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Question
b. Remove the patient from the emergency
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department.
c. Increase your distance from the patient.
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d. Immediately call the police department.
What should the emergency department worker a. Use a firm voice and say, “Call security!” say or do when a patient shows signs of
increasing escalation (e.g., derogatory name
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calling, cursing) and additional help is needed from the coworkers standing nearby?
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The physician informed the mother of a twoyear-old critically ill patient that test results
b. Look at the patient and say, “You will not talk to me like that.”
c. Document the event in the medical record d. Use a hand gesture to indicate help is needed
a. Evict the mother from the emergency department b. Tell your coworkers about the violent event
mother becomes verbally and physically
c. Complete an incident/safety event report
violent. After the violence has stops, what
d. Expedite the patient’s admission to the
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indicate the patient may have cancer. The
intervention should be performed first?
pediatric ICU
ACCEPTED MANUSCRIPT 20 Table 2. Demographic characteristics of the study sample (n=120).
Female
104
Male
16
White
112
Black/Other
8
13.3%
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Race
86.7%
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Sex
%
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N
Ethnicity Hispanic
93.3% 6.7%
2
1.8%
110
98.2%
1
0.8%
16
13.3%
26
21.7%
Bachelor’s degree
69
57.5%
Master’s degree
8
6.7%
Day shift
49
40.8%
Evening shift
35
29.2%
Night shift
26
21.7%
Variable shift
10
8.3%
Non-Hispanic
High school Some college
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Associate degree
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Educational attainment
Primary work shift
ACCEPTED MANUSCRIPT 21 Occupation 86
71.7%
Respiratory therapist
6
5%
Child life specialist
2
1.7%
Paramedic
14
Patient care assistant
12
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Registered nurse
11.7%
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10%
ACCEPTED MANUSCRIPT 22 Table 3. Standard
Paired difference
Paired difference
deviation
(T2-Tn)
(T3-Tn) 8.250
Time 1 (T1)
58.5
10.6
3.208
Time 2 (T2)
61.8
10.1
-
Time 3 (T3)
66.8
9.3
-5.042
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Mean
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5.042 -
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Figure 1. Attrition chart.
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Figure 2. Boxplot distributions displaying participant test scores.
