Violence Prevention Climate in General Adult Inpatient Mental Health Units: Validation study of the VPC-14

Examining the utility of the Violence Prevention Climate scale: In a metropolitan Australian general hospital

AIM AND OBJECTIVES

To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals.

BACKGROUND

Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate.

DESIGN

A cross-sectional survey using the STARD guidelines was used.

METHODS

The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open-ended question on violence prevention management strategies was also conducted.

RESULTS

Comprising of 14 items with two factors (patients and staff), the study revealed a 9-item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies.

CONCLUSIONS

The use of the 9-item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting.

RELEVANCE TO CLINICAL PRACTICE

The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence.

Safewards: Changes in conflict, containment, and violence prevention climate during implementation

Since its development, there has been growing utilization of the Safewards package of interventions to reduce conflict and containment in acute mental health wards. The current study used the opportunity of an implementation of Safewards across one large metropolitan local health district in New South Wales Australia to evaluate change. Specific aims of the study were to measure, for the first time in Australia, changes in shift-level reports of conflict and containment associated with Safewards introduction, and to measure any association with change in the violence prevention climate using a tool validated for use in the current study setting. Eight of eleven wards opted-in to participating in Safewards. Implementation was conducted over a period of 24 weeks (4-week preparation, 16-week implementation, and 4-week outcome phases). Conflict and containment were measured using the Patient-Staff Conflict Checklist Shift Report and violence prevention climate using the VPC-14. From 63.2% response rate, the mean (SD) reported conflict and containment incidents per shift fell from 3.96 (6.25) and 6.81 (5.78) to 2.94 (4.22) and 5.82 (4.62), respectively. Controlling for other variables, this represented reductions of 23.0 and 12.0%, respectively. Violence prevention climate ratings did not change. Safewards was associated with significant improvements in all incidents of conflict and containment, including the most severe and restrictive types, and this was largely unaffected by outcomes measure response rate, shift or weekday/weekend reporting, or number of ward beds. Safewards is increasingly justified as one of very few interventions of choice in adult, acute mental health services and should be widely utilized.