An Evaluation of Violence Prevention Education in Healthcare

Abstract

BackgroundAn issue of international concern, violence towards healthcare workers from patients and visitors negatively affects the safety and health of workers and the quality of care they deliver. The principal intervention to address violence has been violence prevention (V.P.) educational programs for healthcare workers. Evaluating the overall effectiveness of V.P. education has been difficult due to pervasive underreporting of incidents, the complexity of healthcare settings, and the varying reasons for violence.MethodsA theory-driven, realist evaluation was conducted to examine the conditions under which V.P. education is effectively learned and applied in emergency department (E.D.) settings. Nine research sites included three rural, three community and three urban, tertiary care hospital E.D.s. Data from individual and focus group interviews with 136 participants was used to test a program theory of why and how V.P. education works for whom under what circumstances.ResultsThe initial program theory of V.P. education was based on a realist literature review with input from content experts. Qualitative data from the evaluation refined the initial program theory, yielding 15 explanations for how and why educational and workplace contexts influence E.D. workers' learning and application of V.P. knowledge and skills--- ultimately reducing the risk of violence. Explanations focused on V.P. education delivery and content, factors influencing knowledge and skills application in E.D. settings, and follow-up after a violent incident.ConclusionsThis research provides practical evidence for healthcare stakeholders to inform policy and practice decisions to increase the V.P. education effectiveness.

Keywords: Occupational health, patient violence, violence prevention education, realist evaluation, emergency departments