The Effect of ACT-SMART in Managing Aggressive Situations

1
The Effect of ACT-SMART in Managing Aggressive
Situations

• Donna Cahill, RN, MSN c, CEN

A World of Healing!
2
Managing Aggressive Situations

• ACT SMART (Attitudes Communication Techniques
  for Scripps Mercy Aggression Reduction Training)
• Provides
• Content focuses on
• theory, professionalism self awareness,
• understanding cycle of aggression violence,
• specific de-escalation communication techniques
• Scenario driven case study for real world
  application.
• Communication skills to effectively assess
  interact with aggressive patient situations.

A World of Healing!
3
Managing Aggressive Situations

• Aggression violence
• Public Heath problem of international
  proportions
• Threatens human rights, undermines health, the
  right to life and right to be treated with
  respect
• Increase in societal violence (Rippon, 2000)
• Involves patient, patients family members the
  nurse
• Poses significant risks for nurses
• Creates unsafe work environment
• (International Council of Nurses,( ICN), 2001
  World Health Organization, (WHO), 2002).

A World of Healing!
4
Managing Aggressive Situations

• Emergency Nurses Association (ENA) recent survey
  of gt 1000 ED nurses (Spader, 2007)
• 86 reported being the victim of violence in last
  3 years
• 19 reported experiencing violence in the
  workplace daily.
• ANA found only
• 20 of nurses felt unsafe in current environments
  (OSHA, 2004)
• Bureau of Labor Statistics (2004)
• reported 50 of all nonfatal injuries from
  assaults violent acts were perpetrated in
  healthcare and social service settings.
• Reporting of aggression is infrequent there
  exists a perception that it is part of the job!

A World of Healing!
5
Managing Aggressive Situations

• OSHA defined a safe work environment
• free of violent threats, actions hazards
• likely to cause death or serious emotional
  physical harm.
• Consequences for the nursing profession
• Frustration stress affect clinical performance,
  patient safety, attitudes, confidence and
  personal job satisfaction
• Increase work compensation cases sick time use

A World of Healing!
6
Managing Aggressive Situations

• Factors affecting escalation of aggression
  violence ( Holleran, 2006)
• Environmental
• Rapid pace, 24 hour accessibility, noise
  stimulation, privacy, wait times, lack of comfort
  and distractions, patient acuity, shear volume of
  patients
• Patient family
• Family fragmentation
• History of drug alcohol, poor coping skills
• Unexpected emergency or trauma
• Stress and Frustration
• Nurse related

A World of Healing!
7
Managing Aggressive Situations

• Significance to Nursing
• Service oriented profession
• Model behaviors of care, compassion empathy
• Aggression violence are diametrically opposed
  to ideals of the nursing profession
• Impact quality of patient care delivered
• Safe Work environment

A World of Healing!
8
Managing Aggressive Situations

• Statement of the Problem
• ED Nurses are not adequately prepared , educated
  or trained regarding conflict resolution and
  aggression management (Ergun Karadodovan, 2005)
  
• Communication is vital
• Inappropriate communication
• Results in stress frustration
• Gives rise to escalation of aggression (Racette,
  2001)

A World of Healing!
9
Managing Aggressive Situations

• Statement of Purpose
• Understanding of aggression violence
• Create programs to identify, control, intervene
  mitigate
• Focused education training-
• Provides the effective therapeutic communication
  skills that promote safe work environments
  patient satisfaction (Deans, 2004 Kennedy.
  2005).
• Education promotes
• Increased levels of confidence, positive
  attitudes self efficacy (Deans, 2004 Kennedy,
  2005)

A World of Healing!
10
Managing Aggressive Situations

• To address the specific aims of the study, the
  following questions were posed
• Does the ACT-SMART program improve ED nurses
  self reported confidence and attitudes in
  managing aggressive and violent patients in the
  ED?
• What is the reported incidence of aggression and
  violence within the healthcare environment?

A World of Healing!
11
Managing Aggressive Situations

• IRB approval was received from both PLNU
  Scripps Mercy
• Design
• Quasi- experimental study pre-test/post test with
  control group
• Instrument used
• Incidence of and Attitudes toward Aggression in
  the Workplace (Deans, 2004)

A World of Healing!
12
Managing Aggressive Situations

• Sample
• Convenience sample of nurses attending eight hour
  educational sessions were recruited between March
  July of 2007 (N65)
• Experimental group (n 56) 12 ED nurses. Attended
  ACT- SMART
• Control group (n 9) attended a basic trauma
  workshop
• Setting- campus of tertiary Level 1 trauma center

A World of Healing!
13
Managing Aggressive Situations

• Data Analysis
• SPSS computer based program
• Descriptive statistics
• Analyze demographic pretest incidence of
  aggression
• Bivariate Pearsons correlation procedure
• Examine relationship between demographic
  variables incidence of aggression violence
• A paired t-test used
• compare mean scores between pre-test post-test
  scores of confidence attitudes
• An independent t-test- compare mean scores
  between experimental control group

A World of Healing!
14
Managing Aggressive Situations

• Study results - after attending ACT- SMART
• Experimental group significantly improved their
  mean scores on confidence in managing aggressive
  situations
• (p lt 0.001)
• No statistical difference was noted in mean
  scores of attitudes toward managing aggressive
  situations
• (p 0.298)
• 25 of respondents reported
• weekly incidence of verbal aggression
• Verbal aggression identified as
• verbal insults, verbal threats, yelled at

A World of Healing!
15
Managing Aggressive Situations

• Limitations
• Small sample size ( 12 ED RNs)
• Tool
• Questions not generalized to all healthcare
  providers
• Conclusions
• Study suggests incidence of verbal aggression is
  remarkably high
• ACT SMART appropriate for all HCP may improve
  overall patient care and safety.

A World of Healing!
16
Managing Aggressive Situations

• ACT -SMART program
• improved confidence in managing patient
  aggression
• Continue evaluation for content curriculum
  needs
• Sustainability /
• Long term arm to study
• Education makes a difference
• Provides nurses with improved communication
  skills techniques
• Builds confidence for managing aggression
  violence

A World of Healing!
17
Managing Aggressive Situations

• ACT-SMART may be useful
• in improving overall patient care
• be appropriate for ALL healthcare providers
• Supports
• Safe work environment
• Patient satisfaction
• Nurse satisfaction

A World of Healing!
18
Code 55
Anger defused by walking with patient
Music to calm
Security Therapy Dog
19
Managing Aggressive Situations

• Deans, C. (2004). The effectiveness of a training
  program for emergency department nurses in
  managing violent situations. Australian Journal
  of Advanced Nursing, 21(4), 17-22.
• Ergun, F. Karadokovan, A. (2005). Violence
  towards nursing staff in emergency departments in
  one Turkish city. International Nursing Review,
  52, 154-160.
• http//www.ena.org/publications/statements/Positio
  nPDF/Violence-in-ED.PDF
• http//www.osha-slc.gov/Publications/osha3148.pdf
• Holleran, R. (2006). Preventing staff injuries
  from violence. Journal of Emergency Nursing,
  32(6), 523-524
• International Council of Nurses (2001). Nurses
  always there for you United against violence.
  Anti-Violence Tool Kit, ICN, 3 Place
  Jean-Marteau, 1201, Geneva, Switzerland.

20
Managing Aggressive Situations

• Kennedy, M. (2005). Violence in emergency
  departments Under-reported, unconstrained and
  unconscionable. The Medical Journal of Australia,
  183(7), 362-365.
• OSHA, U. S. Department of Labor Occupational
  Safety Health Administration, (2004).
  Guidelines for preventing workplace violence for
  health care and social service workers. Retrieved
  February 11, 2007, from http//www.osha.gov/OshDoc
  /data_General_Facts/factsheet-workplace-violence.p
  df
• Spader, C. (2007). Not my Job. ED Nurses
  Specialty Guide, 32-33.
• Racette, K. (2001). Violence in the workplace.
  Radiologic Technology, 72 (4), 329-340.
• Rippon, T. (2000). Aggression and violence in
  health care professions. Journal of Advanced
  Nursing, 31 (2), 452.
• World Health Organization, (2002). World report
  on violence and health. Geneva. Retrieved October
  7, 2007, from http//whqlibdoc.who.int/hq/2002/924
  1545615.pdf