1. Workplace Violence Among Nurses: The Minnesota Nurse’s Study Epidemiology Nursing 702 Maria-Idalia O. Lens, RN, PHN, MSN, FNP-C

2. Work Setting Work Setting Inpt Setting 534 physicians, 341 beds, 14-bed preoperative, 60 critical care beds Medical/telemetry floor (32 beds) Every week there are encounters between patients, staff, family members. Mostly are verbal, however, few become physical.

3. Current Policy Call security Call police if necessary Use restraints Use medications Use sitter (1:1) care Press charges if severe assault Member loses coverage

4. One bad episode: Pt had physical contact with another pt, 3 staff, and ANM. This has led to closure of the room, PTSD for staff and other pt involved. Staff/staff confrontation. Currently defense classes being taught to staff as well as how to deescalate possible violent situations. Care classes based on Jean Watson’s Theory. http://currentnursing.com/nursing_theory/Watso n.html http://currentnursing.com/nursing_theory/Watso n.html

5. Minnesota Nurses’ Study To identify magnitude and potential risk factors for violence among an occupational population (nurses). Collection of data done through surveys among RNs, and LVNs. Collect data on physical and non physical violence in a 12 month period. Results: Most violence is instigated by patients or clients; certain factors found to contribute to violence.

6. Work Violence Violent acts including physical assault, threats of assault directed to persons who are on duty. In 2001, 639 work related homicides (3 rd leading work related cause of death in workers, 2 nd among women). Most research is based from public policy.

7. In California, 82.5/100,000 (0.08%) related occupational injuries. Occupational homicide 1.3/100,000 (0.0013%). In California, (hospital workers) non-fatal assault 465/100,000 (.46%). Work violence among nurse known, but risk factors unknown.

8. Methods RNs: n=57,388, LVNs: n= 21,740 Gathered from state database Random sample of 6300 chosen to participate with 78% return rate. Violence included: physical assault, non- physical threats,

9. Data Collection Data Collection Done in 2 phases: Phase 1: Estimate frequency and consequences of work related violence and identify risk factors. Phase 2: Use case-control approach to identify specific risk factors for the assault outcomes.

10. Surveys sent to nurses (up to four times). Survey designed specifically related to work violence.

11. Data Analysis Analysis based on reported events and consequences from events. All variables were considered based on directed acyclic graph (DAG).

12. Results CharacteristicsNumberPercentage GenderMale: 151 Female: 35874% / 96% Age40-5038.5% License TypeRN/ LVN74.6% / 25.4% Nursing EducationDiploma/AND/BSN/ MSN38.6% / 28.3% / 26.2% / 5.8% Primary Facility WorkedInpt / Nursing Home38.9% / 18.4% Ownership of facilityPrivate / unsure67.1% / 11.1% Primary DepartmentMed/Surg/ Public Health40.1% / 15.6 % Primary population Primary Activity Adult / Geriatric Pt care / non-direct care 42.6% / 23.4% 62% / 31.4%

13. Characteristics of Perpetrators CharacteristicsPhysical EventPhysical (Ongoing) Non-physical Patients96.8%90.7%67.2% Impairment89.5%90.7%51.3% Disease related79.9%87.0%41.2% Male58.8%55.6%73.1% Female40.5%50%50.6% Age Range 25-346.5%3.7%25.2% 35-6518.3%13%54.4% 66 or older64.4%70.4%30.8%

14. Clinical Significance From this study, we know that physical work related violence in nurses is from inpt settings, med/surg areas, in the adult population, while providing direct care. In addition, related to neuro impairment/or disease, in adults older then 66.

15. Implications for Practice Develop a policy among patients with certain diagnosis and illness to help prevent physical violence among nurses. Prevent PTSD among nurses. Increase pt/nurse safety. Have psych or Geriatric/Neuro CNS/NP to evaluate pt’s within 24 hours to appropriately diagnose and treat.

16. Implications for Practice Give appropriate medications to pt’s/ everyone responds differently to certain medications. http://www.premieroutlook.comsummer_ 2004/medications_and_behavior.html http://www.premieroutlook.comsummer_ 2004/medications_and_behavior.html

17. Education and Research Educate staff on self defense, but also on statistics and other medications that can be used. Do research specific to geographic location and population. Be able to recognize possible physical altercations before it happens.

18. Develop policy and protocol related on what nurses can do before it happens. Gather data on facilities own statistics and develop policy and protocol based on data. Work collaboratively with physicians, specialists, and etc…

19. Questions ????

20. References *