Improving workers’ ability to manage violence in the acute psychiatric ward of a Taiwanese medical center

SHIH-CHUAN WANG^{* 1} , MING-FANG HO² , YI-CHUN LIN¹ , MENG-HAN SYU¹

¹BSN, RN, Department of Nursing, Chang Gung Memorial Hospital, Linkuo,

²BSN, RN, Psychiatric ward Head Nurse, Department of Nursing, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan

 

Introduction

According to the 2020 Taiwan Patient Safety Reporting System (TPR), there were 5,102 violent behaviors in psychiatric hospital safety reports, of which physical assault ranked first, making up 67.5% of all reported incidents. The lack of awareness and ability to handle the situation can physically and mentally affect healthcare workers. It indirectly reduces their motivation and impacts the quality of care. This shows that violence is an important issue facing the field of psychiatry, and the author has therefore been motivated to explore the topic. This paper aims to increase psychiatric ward workers’ ability to handle violent activity to ensure their safety in the violence management process.

Methods

 To understand the current situation regarding violent incidents on the ward in this study, data collection was carried out through consulting document records, questionnaire surveys, and on-site observations of violence management. The focus was on the team of workers on the ward. As a result, from January to April 2021, four violent incidents occurred, and the injury rate of violent incidents reached 0.2%, exceeding the 0.05% monitoring threshold of the Taiwan Clinical Performance Indicator (TCPI).

Observations of the current situation showed that the correct rate of violence awareness among ward staff was only 68%, and the correct rate of violent incident management was 74%. The following reasons for the occurrence of violent incidents were identified: 1. Insufficient knowledge of violence within the ward team, and 2. A lack of a staff auditing system. The following targets were set: 1. The correct rate of violence awareness should reach ≧90%, and 2. The correct rate of violence management should reach ≧95%.

This study was planned, implemented, and evaluated from 26^th June 2021 to 1^st April 2022 by creating teaching videos that simulate violent incidents, increasing the number of cross-departmental drills on violent incidents, and creating a violence management auditing process. In addition, tests were conducted before and after the study to judge these measures' effectiveness.

 

Results

After implementing the new measures, the ward team's correct rate of violence awareness increased from 68% to 91%. Likewise, the correct rate of violence management increased from 74% to 96%, demonstrating these measures' effectiveness.

 

Conclusion

After implementing the measures in this study, the ward team expressed that they could effectively identify the precursors to violence after increasing training on violent incidents and watching educational violent incident simulation videos. When violence occurred, they could immediately delegate work to the violence management team, which prevented and reduced the occurrence of injuries, indirectly improved the safety of the work environment, and left the team members satisfied and at ease. In addition, through continuous auditing and tracking the effectiveness of the interventions, the violence awareness rate has been maintained at 91% and the management rate at 96%, so the ward has continued to audit violence awareness and drills of violent incidents twice a year to maintain the effectiveness of the intervention.

When violent incidents occur, they can easily cause harm to team members on the ward. I hope this article can provide a reference for colleagues working in the field of psychiatry to understand the importance of and be able to maintain a safe working environment and reduce the occurrence of injuries while managing violent incidents.

 

Keywords: violence and injury on psychiatric wards, awareness of violent incidents, management of violent incidents