Medical facilities adopt evidence-based (EB) change to achieve better outcomes. The change project is determined by the clinical problem to be addressed. The Quality improvement specialists collaborate with nurse researchers to collect evidence-based data related to the clinical issue from existing literature. The knowledge gathered through a review of the literature is translated into EB intervention and implemented in the affected department or the entire medical facility. In this case, the KTA implementation addresses workplace violence (WPV) among emergency room department nurses.
Clinical Problem
The clinical concern to be addressed involves a dramatic increase in incidents of workplace violence against emergency room department nurses. According to Al-Qadi (2021), violence against nurses in healthcare settings is a significant global public safety concern. Patients or family members expose about 25% of registered nurses (RNs) to physical assault. Additionally, over 50% of RNs are exposed to bullying or verbal abuse (Al-Qadi, 2021). WPV has increased by 23% in healthcare organizations, becoming one of the most common fatal events. Annually, violent behaviors represent approximately 1.7 million and 900 nonfatal assaults and workplace homicides, respectively (Al-Qadi, 2021). Emergency department (ED) nurses are more prone to various forms of abuse, including psychological, physical, verbal, and sexual, than medical professionals operating in other units (Al-Qadi, 2021). In particular, violent behaviors against emergency department nurses occur when these healthcare professionals are threatened, assaulted, or abused in the line of duty in clinical settings. WPV exposes emergency department nurses to various mental health issues, including post-traumatic stress disorders, anxiety and sleep disorders, and depression. Additionally, violent behaviors against ED nurses result in a high rate of absenteeism, reduced job satisfaction, lost productivity, and high nurses turnover rates (Al-Qadi, 2021). Therefore, evidence-based measures should be adopted in the ED to reduce the high rate of WPV against nurses and related adverse outcomes.
Practice Setting Affected by Increased Workplace Violence
The practice setting significantly affected by increased incidents of WPV is the ED of a hospital with a bed capacity of 950. The hospital’s top management has invested in a robust clinical pool and essential resources, which present a traditional office-based care setting. The medical facility is located in a metropolitan city. The city has a population and population density of 7 million and 2,500 per square mile, respectively. The hospital provides a wide range of medical care to Americans residing in the metropolitan city and its neighborhood. The ED provides unplanned acute care services to chronically ill or severely injured patients presented to the hospital, preventing potential adverse health outcomes, including death (Ho, 2020). Therefore, the ED significantly enhances the medical facility’s ability to provide life-saving care to patients seeking emergency medical services.
However, the ability of ED nurses to meet patients’ needs is compromised by a dramatic increase in workplace violence incidents. The rate of violent behaviors in the ED has increased by 25% in the last 2 years. Nurses working in this unit are either physically, psychologically, or verbally abused by patients or visitors. As a result, ED nurses are predisposed to work-related distress and physical injuries. Additionally, violent behaviors against ED nurses increase absenteeism and turnover rate, compromising the safety and health of patient care due to increased workload among the current critical care nurses. Studies show that patients and visitors” mistreatment of medical professionals compromises the safety and quality of care (Yan et al., 2023). Therefore, the ED department’s ability to adopt an EB change project for preventing WPV should be evaluated to determine whether the proposed new intervention will be successfully implemented.
The Practice Weaknesses that Would Resist the Proposed Change
The hospital’s ED should implement an EB intervention. Adopting an EB change project would significantly reduce the current rate of WPV incidents and related potential adverse outcomes. However, various internal factors would hinder the successful implementation of the proposed change project.
First, the hospital’s profit-driven corporate models and management structure prioritize patient satisfaction. Private-oriented healthcare organizations deter medical professionals from holding patients responsible for their violent behaviors against medical providers during the care process (Yan et al., 2023). Thus, the ED’s top management dismisses cases of WPV against ED nurses reported in the unit. The unit leader believes that patients are always suitable and that taking any legal action against them for their violent behaviors would make them dissatisfied with the hospital’s services. As a result, patients would switch to the competitors’ medical care services, reducing the hospital’s revenue and return on capital. Therefore, the ED management would be reluctant to support change projects designed to curb violent behaviors against nurses in the unit.
ED nurses ‘ high workload is another significant barrier to adopting the proposed change project. Successful implementation of EB change projects in clinical settings requires QI specialists to involve multidisciplinary team members throughout the implementation process (Albott et al., 2020). These interprofessional team members work in the practice area affected by the clinical problem of concern; hence, they provide essential data that contribute to the successful implementation of the EB intervention. Thus, ED nurses should be involved in the implementation of the EB change project designed to curb WPV since they are the most common victims of violent behaviors in the department. However, ED nurses have a high workload and long working hours due to the comprehensive nature of patient care provided in the emergency department. Hence, it is difficult for ED nurses to participate in the implementation of the EB project due to their competing needs, which would jeopardize the implementation process.
Opportunities related to the Change Project
The new change provides the ED with potential opportunities. First, adopting the EB intervention for addressing WPV increases the ED’s likelihood of being accredited by quality and safety agencies, such as the Joint Commission (JC). This organization primarily empowers healthcare organizations to create a strong foundation for patient safety and quality care (Azmi et al., 2020). The JC provides recommendations for addressing clinical issues that might compromise the safety and quality of patient care. Specifically, the JC has provided workplace prevention program guidelines to curb violent behaviors against medical professionals in clinical settings to settings to enable them to offer high-quality and safe patient care. Therefore, the ED would receive the JC’s accreditation upon implementing the EB project to prevent WPV against ED nurses.
Moreover, implementing the EB change will enable the ED’s key stakeholders, including the management and interprofessional team members, to work with QI specialists. In clinical settings, QI specialists identify clinical issues that can be addressed through change implementation (Mathew et al., 2021). The QI team reviews current literature to identify the most appropriate EB approach for improving the quality or safety of care (Mathew et al., 2021). Consequently, implementing the proposed change in the affected practice area results in the desired clinical outcomes. Thus, working with highly competent QI specialists during the implementation of the EB project will successfully reduce the cases of WPV incidents by ED nurses.
Threats associated with the EB Change Project
Industrial forces might compromise the EB intervention implementation process. First, the new EB project for preventing violent behaviors against ED nurses might significantly reduce the hospital’s market share and revenue. The hospital operates in a metropolitan city with many highly-equipped hospitals. Studies show that multifactorial WPV prevention programs effectively reduce workplace violence incidents in clinical settings (Yusoff et al., 2023). Thus, the proposed EB approach for fighting WPV in the ED will require patients and their families to be held responsible for any form of violence or abuse against emergency department nurses. Consequently, the patients might be dissatisfied with the hospital’s services; hence, they may seek treatment services from other medical facilities in the city. The change in medical care services provider will lower the hospital’s market share, revenue, and profit margin.
Moreover, the change implementation will expose the hospital to the high cost of hiring a team of QI specialists at the current market rate. WPV is a complex clinical issue that can only be addressed through multiple strategies and approaches (Spencer et al., 2023). For this reason, the hospital’s management must engage a team of highly competent QI specialists to successfully formulate and implement the most appropriate EB-based WPV prevention program. Highly competent and qualified QI specialist have set a relatively high service fee due to the high demand for their services. Thus, hiring these costly QI specialists will impose a substantial financial burden on the hospital, reducing its profit margin.
Conclusion
The increased number of cases of WPV in the ED is a significant nurse’ safety issue that must be addressed by implementing an EB intervention. Analysis must be conducted to determine the likelihood of the EB project being successfully implemented in the ED. The hospital’s corporate models, management structure, and ED nurses’ high workload would hinder the EB intervention implementation process. The proposed change will create opportunities, including accreditation by quality and safety regulatory agencies. Additionally, implementing the new intervention will allow the hospital’s stakeholders involved in the implementation process to work with highly experienced QI specialists. However, the change would threaten the medical facility, lowering the market share and exposure to a substantial financial burden.
References
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