Wim Janssen W A Janssen Ph D Senior

Wim Janssen W. A. Janssen Ph. D Senior lecturer. 24 -10 -2019 WORKPLACE AGGRESSION AGAINST STUDENT NURSES.

School of nursing studies Totally: 650 students 3 courses Propaedeutic phase Second year Third year Fourth year Introduction Full-time course Part-time courses: Ø Part-time course minimal 28 hours a week. Ø Working and learning course (36 hours a week) Internships Traineeship Full time in school 3 days a week (20 weeks) 4 days a week (40 weeks) 4 days week during year

Content • Introduction • Literature • The research question and objectives • Methodology • Results • Conclusion • Discussion Content

Aggression against nurses • Insert pictures about aggression against health care staff Introduction

Aggression against nurses: some definitions • Aggression: Any verbal, non verbal or physical behavior that is threatening or physical behavior that actually harm (to self, others or property) (Morrison, 1990). • Aggression: Any act that harms another individual who is motivated to avoid such harm (Baron & Richardson, 1994). • Workplace aggression: Perpetrator has a legitimate relationship with the business and becomes violent while being served by the business (Phillips, 2016). Definitions

Aggression against nurses; some figures Several studies on/of aggression against nurses and health care workers: • All clinical nurses are at risk of clinical aggression (Thompson, et al. 2019). • 75% of all nurses experience more than one aggression incident (Leeuwen & Harte, 2015, Phillips, 2016). • 25% of the aggression incidents result into injuries and pain for some time (Spector, et al. 2014, Leeuwen & Harte, 2015). • 5% of aggression incidents sustained into serious physical injuries (Leeuwen & Harte, 2015). No accurate data is available (Phillips, 2016). Literature

Aggression against nurses; consequences. • Health problems among nurses such as: fear, anger, stress, less able to function at work (Galian-Munoz, et al. 2014), • Interruptions in patient care (Roche, et al. 2010). • Problems with job satisfaction, changing jobs (Gates, et al. 2006, van der Kemp, 2004). Literature

Aggression against nurses: remarkable facts. • Less experienced nurses are more involved in aggression incidents than well-experienced colleagues (Nau, et al. 2010, Zhang, et al. 2017). • In nursing education programs: Little attention is paid to dealing with aggression (Nau, et al. 2010, Pourshaikhian, et al. 2016). • Upcoming nurses: not or insufficiently trained in dealing with aggression (Ministry of Welfare and Sports, 2012). • The Hague University of Applied Science, school of Nursing pays attention only to general communication skills. Literature

Main question • To what extent are students of nursing program at the Hague University of Applied Sciences skilled in dealing with occurring aggression. Main question and goals

Goals of the study • Mapping the aggression in which students of the college of nursing have to deal with. • Gathering experiences of students with aggression incidents. • Empirically leading to a program for the students learning to deal with aggression in a safe way. Main question and goals

Study design • Cross sectional study. • Questionnaire about nature, severity and level preparation in dealing with aggression. • SOAS-r is included to describe the severest aggression incidents over the last 12 months. • Students in propaedeutic phase of the course are excluded. Study design

Description of the respondents Totally 202 students Number of students in traineeship per setting. Results Full-time course Number of students Part-time course Number of students Home Care 28 20 General hospital 22 44 Psychiatric hospital 15 18 Nursing home 16 16 Mental disabled patients 4 6

Reported forms of aggression Number of students in traineeship per setting. Results Number of students Reported forms of aggression Home Care 48 211 General hospital 66 303 Psychiatric hospital 33 225 Nursing home 32 177 Mental disabled patients 10 71 Unknown 13 0 Total 202 987

Reported forms of aggression calculated to one year Number of students in traineeship per setting. Results Number of students Reported forms of aggression Home Care 48 211 Estimated forms of aggression during one year 383 General hospital 66 303 550 Psychiatric hospital 33 225 408 Nursing home 32 177 321 Mental disabled patients 10 71 129 Total 189 987 1791

Reported forms of aggression calculated to one year Number of student in traineeship due to setting. On a Home Care ver General hospital age 10 Psychiatric hospital Results Number of students Reported forms of aggression 48 211 Estimated forms of aggression during one year 383 303 550 225 408 form s of 66 agg re 33 Nursing home 32 Mental disabled patients 10 Total 189 ssio np er s tud 177 ent p 71 er yea r 987 321 . 129 1791

Locking up, tie down. Mental disabled Institutes Treaten with a unknown. . . Nursing Home Other physical violence Psychiatric Hospital Touching General Hospital Attempt to strangle Home Care Expressed aggression as related to health care setting Sticking, cutting, scratching Stabbing with a weapon Bitting Pulling hair, scratching, . . . Treaten with an object Sexual harassment Puching, pulling, holding Attempt to throw with an. . . Hitting, kicking, punching Attempt to hitting Verbally threatening Offending Treaten with knife or weapon Threatening attitude Abusing Results 0 20 40 60 80 100

Severity of experienced aggression Subjective scores Results Objective scores Highest possible score Paired t-test t df sign Home care 1, 709 48 NS General hospitals 3, 719 65 0, 000 Psychiatric hospitals 0, 294 32 NS Nursing homes 1, 142 31 NS Mental disabled inst. -0, 635 9 NS

Students’ opinions about their competences and skills to deal with aggression I felt competent at the start of my internship to deal with aggression I had sufficient skills to handle in an aggressive situation Disagree Mental Disabled Institutes Agree Nursing Homes Psychiatric Hospitals General Hospital Home Care 0 Results Disagree Mental Disabled Institutes 20 40 60 80 0 10 20 30 40 50 60 70

Who has trained students in dealing with aggression? Who has had the most important role in aggression handling training School Institute Mental Disabled Institutes Self Other Nursing Homes Psychiatric Hospitals General Hospital Home Care 0 Results 10 20 30 40 50 60 70

Experiencing aggression is more intense than objective perception Conclusions • Students are often confronted with aggression which has a major impact on them • The most common forms of aggression are: verbal aggression, such as swearing and threatening with. . . , and physical aggression such as touching, grasping. • Experiencing aggression is somewhat more intense than objective description. • Students in the nursing program are not sufficiently skilled in dealing with aggression, therefore dealing with aggression needs to be incorporated in their courses/ curricula. Conclusion

Recommendations Development of a course into dealing with aggression: - Recognizing causes and development of aggression. - Communication skills: to prevent and deal with aggression. - De-escalation techniques. - Some self defense techniques. - Debriefing incidents. Recommendations

Recommendations Student Tr ing ain i ain ng Tr School Recommendations Tuning Health care institutions

Literature. • • • • Allen, J. J. , Anderson C. A, . & Bushman B. J. (2017). The General Aggression Model. Current opinion in Psychology. 19, 75 -80. Baron, R. A. , & Richardson, D. R. (1994). Human aggression. New York: Plenum Press. Galian-Munoz, I, . Llor Esteban, B. & Ruiz-Hernandez, J. A. (2014) Violence against nursing staff in hospital emergency services, risk factors and consequences. Emergencias. 26, 163 -170. Gates, D. M. , Ross, C. S. & Mc. Queen, L. (2006). Violence against emergency department workers. Journal of Emergency Medicine. 31, 331 – 337. Kemp, S. van der. , van Vree, F. , Knibbe, N. & Knibbe, H. (2004). Evaluatie Arboconvenant GGZ. Leiden. Sectorfondsen Zorg en Welzijn. Leeuwen, van, M. E. & Harte, J. M. (2015). Violence against mental health care professionals: prevalence, nature and consequences. The Journal of Forensic Psychiatry & Psychology. http: //dx. doi. org/10. 1080/14789949. 2015. 1012533 Morrison, E. F. (1990). Violent psychiatric inpatients in a public hospital. Sch Inq Nurs Pract 4: 65– 82. Nau, J. , Halfens, R. , Needham, I. & Dassen, T. (2010). Student nurses‘ de-escalation of patient aggression: A pretestposttest intervention study. International Journal of Nursing Studies. 47, 699 -708. Phillips J. P. (2016). Workplace violence against Health care workers in the United States. New England Journal of Medicine. 374, 1661 -1669. Pourshaikhian, M. , Abolghasem Gorji, H. , Aryankhesal, A. , Khorasani-Zavareh, D. & Barati, A. (2016). A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel. Archives Trauma Research. 2016 Mar; 5(1). doi: 10. 5812/atr. 28734 Roche, M. , Diers, D. , Duffield, C. & Catling-Paull, C. (2010). Violence toward nurses, the work environment, and patient outcomes. Journal Nursing Scholarship. 42, 13 – 22. Spector, P. E. , Zhou, Z. E. , & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies, 51(1), 72 -84. Thompson, R, . Thomson, H. , Gaskin, C. & Plummer, V. (2019). Nurses’ attitudes toward management of clinical aggression; A mixed methods study using actor-based simulation. Medsurg Nursing. 28, 219 -226, 233. Zhang, L. , Wang, A. , Zhou, Y, . Xie, X. , Li, J. , Yang, L. & Zhang J. (2017) Workplace violence against nurses: A crosssectional study. International Journal of Nursing Studies. 72, 8 -14.

Thank you for your attention Wim A. Janssen Ph. D MSc RN The Hague University of Applied Science Mail: w. a. Janssen@hhs. nl Phone: 0031 6 2837 4815