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Study Surmounts Barrier to Measuring Healthcare Worker Exposure to Workplace Violence

Exposure rates to patient aggression measured in real time using Aggressive Incident and Management Logs Tuesday, February 27, 2024

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(OAKBROOK TERRACE, Illinois, February 27, 2024) – Workplace violence (WPV), including physical assaults and verbal threats, is a pervasive and significant issue for healthcare workers and organizations. WPV directly harms healthcare workers and increases their anxiety, depression and staff turnover. It also adversely affects patient safety. Rates of WPV are likely underestimated because past studies have mostly used surveys that rely on recall of past events.

A study featured in the March 2024 issue of The Joint Commission Journal on Quality and Patient Safety (JQPS) overcomes this important barrier by precisely measuring nurse and patient care assistant exposure rates to patient aggression in real time, shedding light on prevention and management measures.

“Our study is critically significant as it unveils the staggering extent of violence faced by healthcare workers,” says Joanne DeSanto Iennaco, PhD, APRN, PMHNP-BC, FAAN, FFNMRCSI, principal investigator of the study, professor of Nursing and Psychiatry at Yale University School of Nursing and School of Medicine, and director of the Post-MSN Clinical DNP Program at Yale University in New Haven, Connecticut. “Of great concern, our findings demonstrate that staff are confronted with aggressive behaviors practically every time they step foot in the hospital. Furthermore, our investigation reveals the distressing impact of these behaviors, as staff commonly report heightened anxiety and feeling threatened.”

The research team examined the incidence of patient and visitor aggressive events toward patient care staff on five inpatient medical units in a community hospital and an academic hospital setting. Patient care staff included nurses and nursing assistants. Data was collected using Aggressive Incident and Management Logs (AIM-Logs) and demographic forms over a 14-day period in early 2017.

A total of 179 aggressive events were recorded, resulting in a rate of 2.54 aggressive events per 20 patient-days. Patient verbal aggression rates (2.00 events per 20 patient-days or two events daily on a 20- patient bed inpatient unit) were higher compared to physical aggression rates (0.85 events per 20 patient-days). The staff aggression exposure rate was 1.17 events per 40 hours worked.

The most common precipitants of WPV included:

  • Medication administration (18.6%)
  • Waiting for care (17.2%)
  • Delivering food/drinks (15.9%)

Most aggressive events occurred during the day shift (50.7%), whereas evening or night shift aggressive events were fewer in comparison at 24.3% and 25%, respectively. Most events were managed with verbal de-escalation (75.2%) as the only intervention.

The researchers concluded that quality improvement leaders can use the AIM-Logs to enhance current data analyses or as post-event debriefing tools to understand common precipitants and severity levels within their own organization. The findings provide insight into areas for future research on preventing aggression and understanding as well as reducing its impact on healthcare workers.

“Cost-effective mitigation and prevention plans require evidence-based decision-making and process implementation,” notes an accompanying editorial by James P. Phillips, MD, FACEP, associate professor, Emergency Medicine, and section chief and fellowship director, Disaster and Operational Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C, and chair, Disaster Medicine Section, American College of Emergency Physicians. “An iteration of the AIM-Log process can be used by hospitals to help identify the scope of violence experienced by their workers and perhaps be convinced by the data to voluntarily prioritize funding for workplace violence prevention programs.”

The March issue is part of JQPS’ 50th anniversary celebration. Each month, a topic of importance to the Journal and The Joint Commission will be highlighted. In addition to the articles described above, the March issue has an open-access list of WPV articles previously published in the Journal, as well as interviews with experts on WPV.

Also featured in the March issue are:

For more information, please visit the JQPS website.

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Note for editors

The article is “The Aggressive Incidents in Medical Settings (AIMS) Study,” by Joanne DeSanto Iennaco, PhD, APRN, PMHNP-BC, FAAN; Elizabeth Molle, PhD, RN; Mary Allegra, DNP, RN, NPD-BC, NEA-BC; David Depukat, PhD, RN, PMH-BC; and Janet Parkosewich, DNSc, RN, FAHA. The article appears in The Joint Commission Journal on Quality and Patient Safety (JQPS), volume 50, number 3 (March 2024), published by Elsevier.

The Joint Commission Journal on Quality and Patient Safety

The Joint Commission Journal on Quality and Patient Safety (JQPS) is a peer-reviewed journal providing healthcare professionals with innovative thinking, strategies and practices in improving quality and safety in healthcare. JQPS is the official journal of The Joint Commission and Joint Commission Resources, Inc. Original case studies, program or project reports, reports of new methodologies or the new application of methodologies, research studies, and commentaries on issues and practices are all considered.

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