Joanne DeSanto Iennaco PhD, APRN, PMHNP-BC, FAAN (is Professor and Director, Clinical DNP Program, Yale University School of Nursing.), Elizabeth Molle PhD, RN (is Nurse Scientist, Middlesex Health, Middletown, Connecticut, and Lecturer, Yale University School of Nursing.), Mary Allegra DNP, RN, NPD-BC, NEA-BC (is Director of Nursing Professional Practice, Research, Magnet Designation, and Pregnancy and Birth Center, Middlesex Health, and Lecturer, Yale University School of Nursing.), David Depukat PhD, RN, PMH-BC (is Director, Accreditation and Regulatory Affairs, Yale New Haven Health System.), Janet Parkosewich DNSc, RN, FAHA (is Nurse Researcher, Yale New Haven Hospital. Please address correspondence to Joanne DeSanto Iennaco)
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Abstract
Background
Rates of aggressive events and workplace violence (WPV) exposure are often represented by proxy measures (restraint, incident, injury reports) in health care settings. Precise measurement of nurse and patient care assistant exposure rates to patient aggression on inpatient medical units in acute care hospitals advances knowledge, promoting WPV prevention and intervention.
Methods
This prospective, multisite cohort study 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 in the northeastern United States. Data were collected with event counters, Aggressive Incident and Management Logs (AIM-Logs), and demographic forms over a 14-day period in early 2017.
Results
Participants recorded a total of 179 aggressive events using event counters, resulting in a rate of 2.54 aggressive events per 20 patient-days. Patient verbal aggression rates (2.00 events per 20 patient-days) 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 (verbal aggression exposure rate: 0.92 events per 40 hours; physical aggression exposure rate: 0.39 events per 40 hours). The most common precipitants included medication administration (18.6%), waiting for care (17.2%), and delivering food/drinks (15.9%). Most events were managed with verbal de-escalation (75.2%). The number of patients assigned to patient care staff was significantly greater during a shift when an aggressive event occurred compared to when no event occurred (6.3 vs. 5.7, t = -2.12, df = 201.6, p = 0.0348).
Conclusion
Event counters and AIM-Logs offer greater information about patterns of aggression and preventive interventions used and provide information on the need for debriefing and worker support after aggressive events. Additional studies of this methodology in other settings are needed to evaluate the value of this technology for improving worker and patient safety.
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