Workplace violence prevention training in psychiatric emergency services

Employees in healthcare experience the highest rates of workplace violence, and these violent events are increasing. The rate is elevated in the psychiatric emergency service (PES), and while training programs have been established and studied in other settings, such as general emergency departments, inpatient psychiatric units, training to specifically address this risk in PES is not well-established.

This quality improvement project designed a program specifically to address workplace violence in PES. The purpose of this QI project is to increase staff self-confidence in managing patients who present with aggressive behaviors.

A multidisciplinary training program, Situational Awareness for Emergency Responders (SAFER), was developed to address the risk of workplace violence in the PES of a large Midwest health system in the United States of America. All disciplines working in PES participated in the training. SAFER included a didactic session followed by interactive role-playing learning activities. Using the Clinician Confidence in Coping with Patient Aggression Scale, staff were surveyed pre- and post-training to learn about the effects of the training.

Staff's confidence in their level of training increased from 6.32 to 7.84 [95% CI (0.92-2.13) P < 0.001] for managing physical aggression and from 7.07 to 7.85 [95% CI (0.22-1.34) P: 0.006] for managing psychological aggression. Significant increases were observed across almost all other measurements in staff confidence in managing patients with aggressive behaviors, comparing pre- and post-training.

Staff became more confident in their ability to manage patients exhibiting aggressive behaviors in PES. Including all disciplines typically involved in emergency response to aggression in the workplace in a single training program may promote a more coordinated and effective response to aggression in the workplace. Further research is needed to understand whether SAFER may reduce the rate of workplace violence and staff injuries.