While healthcare workers like nurses and physicians are targets of both physical and verbal violence, they can also become pulled into a situation when a patient is being threatened. Unfortunately, this environment causes enormous upheaval in a place where people are being helped and where those professionals are expecting a safe workplace.
According to the alert, these seven guidelines will help staff report instances of violence and will help create standards for recognizing potential situations, reporting them, preventing future instances, and reacting in an emergency situation.
Recognizing that data come from several sources, capture, track and trend all reports of workplace violence—including verbal abuse and attempted assaults when no harm occurred, but in which the health care worker feels unsafe.
Provide appropriate follow-up and support to victims, witnesses and others affected by workplace violence, including psychological counseling and trauma-informed care if necessary.
Review each case of workplace violence to determine contributing factors. Analyze data related to workplace violence, and worksite conditions, to determine priority situations for interventions.
Develop quality improvement initiatives to reduce incidents of workplace violence.
Train all staff, including security, in de-escalation, self-defense and response to emergency codes.
Evaluate workplace violence reduction initiatives. The Joint Commission
The Commission’s infographic on workplace violence clearly defines what constitutes violence including instances of biting, scratching, intimidating, or yelling. While some nurses encounter these things infrequently, others, like ED nurses where crowding is more common, tensions are high, and some patients might be agitated, will encounter it more often. Either way, reporting such instances will help organizations get a realistic picture of what is happening with patients and staff and make a plan to help fix it.
Nurses who do encounter workplace violence should receive immediate treatment for the physical injuries, but they also will need treatment for the emotional distress. Workplace violence can lead to stress, anxiety, depression, fear, and burnout and impact a person’s quality of life as well as the ability to offer the best patient care possible. The repercussions can’t be underestimated, so nurses shouldn’t brush it off or try to minimize it.
Nurses know how important communication is in the midst of their typically fast-paced and hectic day, and without excellent communication skills, time can be wasted. When nurses need to relay information concisely and quickly to physicians, the SBAR communication method is a favorite way of getting information across.
“SBAR was originally developed by the military as a way to standardize communication,” says Kimberly Mays, RN, MSN, MBA, CJCP and RN consultant with the Joint Commission Resources. SBAR crossed over to medical use when nurses with military experience thought the method would help improve practices, especially when relaying information to physicians quickly, she says. “SBAR helps a nurse organize information for why they are calling a physician,” says Mays.
The SBAR communication method relies on standard steps which a nurse can fine-tune with experience. The acronym stands for the steps needed – situation (state what is going on very briefly); background (relevant information about medications or prior diagnosis); assessment (what you think is going on and needed); and recommendation (what are you asking the physician to do – change medication or reassess patient, etc.).
“It conveys the salient ideas and gives physicians all the information they need to make a decision,” says Mays. Because the information is specific and exact, it helps eliminate any unnecessary data and makes the interaction very precise – just what’s needed in the situation. “When it’s nurse-to-physician [communication], there’s a little more stress because of the roles each of them play in the care of the patient,” says Mays. SBAR condenses the information down into several points – Why am I calling? Why does it matter? What do you want me to do about it?
Mays gives a clear example of a nurse who needs to relay information about a patient’s pain that’s not being controlled with regular medications. The nurse will call the doctor and the facts will be reported in a conversation that might sound something like this – “Mr. Jones continues to have pain. The pain is a 7 out of 10 even one hour after I have ordered his medication. He is a patient of yours and had no other co-morbidities. What do you think about a change in medication to Tylenol 3?”
“It gets what I want for the patient in a timely manner without any confusion in between,” says Mays. “It’s very patient centered in that it only improves the care you give.”
But nurses who use SBAR also learn tricks that make communication with colleagues easier and more efficient. “SBAR promotes critical thinking,” says Mays. As you begin to learn the SBAR method, it’s always a good idea to have someone familiar with the process look over your sheet before you make that call. As you become more familiar with the method, you’ll be able to narrow down your information rapidly.
And because nurses are often not able to recommend a medical treatment and physicians may not accept a medical recommendation, says Mays, SBAR helps you shape your observations and suggestions in a way that might make a physician more agreeable to what is needed. “Communication makes a big difference in how well a nurse’s message is received,” says Mays.