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Evaluate the Evidence
nursing question and need the explanation and answer to help me learn.
Assignment 2: Evaluate the Evidence
Using a two-step process, students will evaluate and synthesize the external evidence
results from the strongest external study
retrieved during the search of the literature that supports the intervention of the PICOT
question formulated in Week 1. This is the study that answer the chosen PICOT question
and directly relate to the chosen intervention. The study must be within the discipline of
nursing and not medicine.
PICOT question:
In nurses working in a hospital setting (P), how does violence prevention training (I),
compared with no training (C), affect the prevalence and magnitude of workplace violence
against nurses in the hospital (O), within a six-month period (T).
I have attached the rubric and explanation for this assignment here :) I did start the table, so
I will include what I have started and the 2 study articles I have used (honestly don't know if
I have done it right so far!). I need a brief analysis as well. I do not have the textbook
available for this course.
Requirements: 1-2pages
Assignment 2: Evaluation Table Template
The only studies to include on this table are those studies that answer the PICOT question
after completing the rapid critical appraisal.
Use abbreviations and create a legend for readers and students.
Keep descriptions brief. There should be no complete sentences. Use bullet points only.
Legend:
WPV: Work Place Violence
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
PROSPERO: International Prospective Register of Systematic Reviews
RN: Registered Nurse
SEAR: South-East Asian Region
WPR: Western Pacific Regions
References
Somani, R., Muntaner, C., Hillan, E., Velonis, A. J., & Smith, P. (2021). A systematic review:
Effectiveness of interventions to de-escalate workplace violence against nurses in
healthcare settings. Safety and Health at Work, 12(3), 289–295.
https://doi.org/10.1016/j.shaw.2021.04.004
Varghese, A., Joseph, J., Vijay, V. R., Khakha, D. C., Dhandapani, M., Gigini, G., & Kaimal, R.
(2021). Prevalence and determinants of workplace violence among nurses in the south‐east
Asian and Western Pacific Regions: A systematic review and meta‐analysis. Journal of
Clinical Nursing, 31(7-8), 798–819. https://doi.org/10.1111/jocn.15987
ReviewArticleASystematicReview:EffectivenessofInterventionstoDe-
escalateWorkplaceViolenceagainstNursesinHealthcareSettingsRozinaSomani1,*,CarlesMunt
aner2,EdithHillan1,AlisaJ.Velonis3,PeterSmith4,51FacultyofNursing,UniversityofToronto,To
ronto,Canada2FacultyofNursingandDallaLanaSchoolofPublicHealth,UniversityofToronto,To
ronto,Canada3SchoolofPublicHealth,DivisionofCommunityHealthSciences,UniversityofIllino
isChicago,USA4DallaLanaSchoolofPublicHealth,UniversityofToronto,Toronto,Canada5Instit
uteforWork&Health,Toronto,CanadaarticleinfoArticlehistory:Received28July2020Receivedi
nrevisedform21April2021Accepted25April2021Availableonline3May2021Keywords:de-
escalationhealthcaresettingsmulti-
componentinterventionsnursessafeworkenvironmentabstractWorkplaceviolence(WPV)isan
increasingcauseofconcernaroundtheglobe,andhealthcareorgani-
zationsarenoexception.Nursesmaybesubjecttoallkindsofworkplaceviolenceduetotheirfrontli
nepositioninhealthcaresettings.Thepurposeofthissystematicreviewistoidentifyandconsider
differentinterventionsthataimtodecreasethemagnitude/prevalenceofworkplaceviolenceagai
nstnurses.ThestandardmethodbyPreferredReportingItemsforSystematicReviewsandMeta-
Analyses(PRISMA,2009)hasbeenusedtocollectdataandassessmethodologicalquality.Altogeth
er,twenty-
sixstudiesareincludedinthereview.Theinterventionprocedurestheyreportoncanbegroupedin
tothreecategories:stand-
alonetrainingsdesignedtoeducatenurses;morestructurededucationprograms,whicharebroad
erinscopeandoftenincludeopportunitiestopracticeskillslearnedduringtheprogram;multi-
componentinterventions,whichoftenincludeorganizationalchanges,suchastheintroductionof
workplaceviolencereportingsystems,inadditiontoworkplaceviolencetrainingfornurses.Byco
mparingthefindings,aclearpictureemerges;whilestandalonetrainingandstructurededucation
programscanhaveapositiveimpact,theimpactisunfortunatelylimited.Inordertoeffectivelycom
batworkplaceviolenceagainstnurses,healthcareorganizationsmustimplementmulticompone
ntin-
terventions,ideallyinvolvingallstakeholders.2021OccupationalSafetyandHealthResearchInst
itute,PublishedbyElsevierKoreaLLC.ThisisanopenaccessarticleundertheCCBY-NC-
NDlicense(http://creativecommons.org/licenses/by-nc-
nd/4.0/).1.IntroductionWorkplaceviolenceposesaseriousproblemforhealthcareor-
ganizations.Unsurprisingly,thehealthcaresystemcanbeachal-
lengingenvironmenttoworkin,withawiderangeofoccupationalhazards,frominfectionsandfall
stochemicalexposure.However,theforemostoccupationalhazardremainsworkplaceviolence,a
ndthisistrueinbothdevelopedanddevelopingcountries[1].Presentlythereisnounifieddefinitio
nofworkplaceviolenceduetoitssubjectivenatureandthevarietyofpersonalandorganizationalb
eliefsandperceptions[2].TheOccupationHealthandSafetyAct,2019definesworkplaceviolence
as“theexerciseofphysicalforcebyapersonagainstaworker,inaworkplace,thatcausesorcouldca
usephysicalinjurytotheworker;astatementorbehaviourthatitisreasonableforaworkertointer
pretasathreattoexercisephysicalforceagainsttheworker,inaworkplace,thatcouldcausephysic
alinjurytotheworker”[3].Expandinguponthis,theInternationalLabourOffice(ILO),Internation
alCouncilofNurses(ICN),WorldHealthOrganization(WHO),andPublicSer-
vicesInternational(PSI)definesworkplaceviolenceas“theinten-
tionaluseofphysicalforceorpower,threatenedoractual,againstoneself,anotherperson,oragain
stagrouporcommunity,thateitherresultsinorhasahighlikelihoodofresultingininjury,death,ps
ychologicalharm,mal-
developmentordeprivation”[4].TheUniversityofIowaInjuryPreventionResearchCenter(UIIP
RC)hascategorizedworkplaceviolenceintofourmajortypes,includingCriminalintent(TypeI),C
ustomer/client(TypeII),Worker-on-
worker(TypeIII),andPersonalrelationship(TypeIV)[7].Yet,regardlessoflingeringuncertaintys
urroundingtheprecisedefinitionofworkplaceviolence,whatiscertainistheconstant*Correspon
dingauthor.FacultyofNursing,UniversityofToronto,155-
CollegeStreet,Suite130Toronto,ONTM5T1P8,Toronto,Canada..E-
mailaddress:rozina.somani@mail.utoronto.ca(R.Somani).ContentslistsavailableatScienceDir
ectSafetyandHealthatWorkjournalhomepage:www.e-shaw.net2093-
7911/$eseefrontmatter2021OccupationalSafetyandHealthResearchInstitute,PublishedbyEl
sevierKoreaLLC.ThisisanopenaccessarticleundertheCCBY-NC-
NDlicense(http://creativecommons.org/licenses/by-nc-
nd/4.0/).https://doi.org/10.1016/j.shaw.2021.04.004SafetyandHealthatWork12(2021)28
9e295
threatitposestohealthcareworkers.Comparedtootheroccupa-
tions,healthcareworkersareathigherriskforvariouskindsofviolenceintheworkplaceduetothe
natureofthehealthcareset-
tingsandoverstressedpeople[5].Nurses,inparticular,areatespeciallyhighriskduetotheirfrontli
nepositionandconstantcontactwithpatientsandtheirrelatives[6].Themajorityoftheseinstance
sofworkplaceviolencearecustomer/client(TypeII)orworker-on-
worker(TypeIII),basedontheUIIPRC’scategorizations[7].Sadly,theratesofworkplaceviolence
againstnursesremainunderreportedduetoawidelyheldbeliefamongnursesthatviolentinciden
tsarearegrettable,butinevitablepartoftheirprofession[8].Perhapsunsurprisingly,workplacevi
olenceisaleadingcauseofjobdissatisfactionamongnursesandcontributessignificantlyto-
wardshighratesofabsenteeismandturnover,aswellascompro-
misedpatientcare[1].IntheUnitedStates,theannualturnoverrateofnursesisestimatedtobebet
ween15%to36%duetoworkplaceviolence[9].Whennursesdoremainintheirrole,theyoftenexp
erienceemotionaltraumaduetoworkplaceviolence,whichcanmanifestaspost-
traumaticstressdisorder,burnout,anxiety,depression,lackofabilitytoperformpatientcare,andj
obdissatisfaction[10].Moreover,workplaceviolencealsohasfinancialramificationsforhealthca
reorganizations.Thisisdueinparttonurseturnovercostsbutalsofromtreatmentforinjuriesresul
tingfromworkplaceviolenceandtimeawayfromworkbecauseofviolence[11].Thephenomenon
ofworkplaceviolenceinthehealthcaresectorhasbeenstudiedbyseveralresearchers,indifferent
contexts.Severalsystematicreviewshavealsobeenconducted.Amongthese,somereviewshavef
ocusedondescriptivestudiestoidentifythemagnitudeandcharacteristicsofworkplaceviolence,
aswellasitsconsequencesonindividualsandhealthcareorganizations[1,5,12].Individualstudie
shaveassessedstrategiestomanageaggressivepatients,aswellasconsequencesofworkplacevio
lence,suchasnurseabsenteeismandjobdissatisfaction[8,13].Theaimofthissystematicreviewist
ofillanexistinggapbyidentifyingstudies,whichproposeeffectiveinterventionstohelpmitigateor
preventworkplaceviolenceagainstnurses.2.MethodThissystematicreviewaimstoanswerthefo
llowingquestion:Whatinterventionsaremosteffectiveatmitigating/preventingworkplaceviol
encetowardsnurses?ThestandardmethodbyPreferredReportingItemsforSys-
tematicReviewsandMeta-
Analyses[14]hasbeenusedtocollectdataandassessthemethodologicalqualityofeachincludedst
udy.2.1.LiteraturesearchmethodsInclusionCriteria:Inordertobeincludedinthisreview,studies
hadtotesttheimpact/effectivenessofinterventionstomitigateorpreventviolenceinhealthcares
ettings,usingRandomizedControlTrials(RCTs),Quasi-
Experimental,andPreandPostdesigns.ThestudieswerepublishedinEnglishwithinterventionsc
onductedbetween2000and2020.Databases:PublishedstudiesweregatheredfromMedline,CIN
AHL,andWebofSciencedatabases.AcombinationofMedicalSubjectHeadings(MeSH),textwords
,andsearchtermswereuti-
lizedinthesearch.Thereferencelistofretrievedarticleswasexaminedmanuallytoidentifyfurthe
rresearchstudiesrelevanttoviolenceinhealthcaresectors.ConceptsandTerms:Thefollowingke
ywordswereuseddur-
ingthesystematicsearchforrelevantarticles:Nurses,nursingstaff,registerednurses,staffnurses,
headnurses,clinicalnurses,nursepractitioners,registerednurseprac-
titioners,practicenurses,nursesupervisor,nursemanager,nurseadministrator,directornursin
g,nursesuperintendent.Healthcaresetting,hospital,workplace,healthcaresectors,healthcares
ettings,healthcarefacilities,inpatientunits,acutecareFig.1.PRISMAflowDiagram,SummaryofSe
archProcess.SafHealthWork2021;12:289e295290
setting,privatehospital,publichospital,generalhospital,govern-
menthospital,occupation,ambulatoryservices,emergencydepartment,tertiarycarecenters.Vio
lence,mobbing,aggression,bullying,incivility,assault,abuse,verbal(violence,abuse,harassmen
t),sexual(violence,abuse,harassment),physical(violence,abuse,harassment),racial(violence,a
buse,harassment),verticalviolence,horizontalviolence.ateralviolence(refertoAppendixAforS
earchStrategy).Participants:Thesystematicreviewincludedallinterventionsconductedonbeha
lfofnursinghealthcareproviders,includingnurses,midwives,nursemanagers,nursingsupervis
ors,clinicalnurseinstructors,clinicalnursespecialists,directorsofnursingservices,nursingsupe
rintendents,headnurses,nursingcasemanagers,workinginprivateorpublichealthcaresettings.
Interventions:Thisreviewhighlightsthebroadrangeofin-
terventionsthatcanbeimplementedtocombatworkplaceviolence,includingtrainingandeducat
ionalsessionsaimedatimprovingknowledgeaboutworkplaceviolence;practicalskillsfornurses
tohelpprevent/minimizeworkplaceincivility,lateralviolence,verbalabuse,physicalviolence,se
xualabuse,andbullying.Thisreviewalsoconsidersinterventionsthathavebeenconductedatano
rganizationalleveltoaddressworkplaceviolencepoliciesandprocesses.2.2.CriticalappraisalEa
chpotentiallyrelevantstudywasevaluatedindependentlyformethodologicalvaliditybythePrim
aryInvestigatorandthethesissupervisor.Aspeciallydesignedchecklistwasusedtoassesseachst
udybasedontheinclusioncriteriaofthissystematicreview.(SeeTable1forselectedstudiesbased
oninclusioncriteriaandcriticalappraisal).Certainarticleswerenotincludedbecausetheydidnot,
forinstance,provideenoughdetailaboutthehealthcaresettingwheretheinterventionwasimple
mentedorthetypeofinterven-
tionusedinthestudy.(refertoAppendixBforstudiesnotselectedforfinalsystematicreview).APRI
SMAflowdiagramprovidesthesummaryofthesearchprocessusedforthissystematicreview(see
Fig.1).2.3.RiskofbiasTheincludedstudieswerescreenedforoutcomereportingbiasbyutilizingP
RISMA,2009guidelines.Theriskofbiasmatrixwasdevelopedtolisttheaims,interventiontested,a
ndoutcomesofeachselectedstudy.Thesewereassessedbycomparingthestudyaim,intervention
tested,andstudyoutcomes.Allincludedstudieswerelabeledaslow,high,orunclearriskofbiasbyt
heprimaryinvestigatorbasedonreportedoutcomesinthegivenarticles.Onlytwostudies[15,16]i
ncludedinthisreviewidentifiedtohaveahighriskofbias.Thestudy[15]involved43nurses,22ofw
homreceivedathree-
houronlinetrainingprogram,andtheremaining21nursesactedasacontrolgroup.Theauthorsme
ntionedthatduetovaliditythreats,diffusionbetweengroups,smallsamplesize,andselectionbias,
theresultswerestatisticallyinsignificant.However,thestudyresultsrevealedastatisticallysigni
ficantdifferencebetweenthecontrolandinterventiongroupsfortherecognitionofverbalandem
otionalabuse,andpost-
trainingreportingofworkplaceviolence.Similarly,a1.5hourseducationalsessionwasimple-
mentedinthestudy[16].Theauthorshaveemailedthepost-
interventionsurveytothestudyparticipants.Theresultsindicatedthattherateoflateralviolences
hiftedfromanincidentinaweektoanincidentinamonth.Thisresultmaybevalidforthestudyparti
cipantsofthissessionbutnotfortheentirestudysetting(refertoAppendixCforAssessmentofrisk
ofbiasmatrix).3.Results3.1.CharacteristicsAltogether,twenty-
sixstudieswereselectedforinclusioninthisreview.Ofthese,fourwereRCTs,tenusedaquasi-
experimentaldesignandtwelveappliedpreandpost-
studydesign.Onlyfourstudies[17e19,42]usedbothquantitativeandqualitativecomponents.Mo
ststudiesincludedinthisreviewwereconductedindevel-
opedcountries.FourteenoftheincludedstudieswereconductedintheUnitedStates[15,16,18,20
e29,42].ThreewereconductedinAustralia[17,30,31],twowerecarriedoutinCanada[32,38],two
inSouthKorea[34,43],oneinTaiwan[42],andoneinSweden[35].Theremainingstudieswerecon
ductedindevelopingcountriessuchasJordan[36],Turkey[37],andPakistan[19].Theprepon-
deranceofworkplaceviolenceinterventionsistakingplaceinthedevelopedcountries.Thelackoft
estedinterventionsindevelopingcountriesisnotsurprising,giventhelackofresearchcapacityan
dfundingavailableintheseregions.(refertoAppendixDforDescriptionofincludedstudies).3.2.M
ajorfindingsThestudiesincludedinthisreviewalltookdifferentapproachestocombatworkplace
violence.However,theapproachescanbegroupedintothreecategoriesbasedonthescopeofthein
terven-
tion.Somestudiesprovidedstandalonetraining,suchasawarenessworkshops.Othersofferedmo
restructurededucationprograms,suchasmultiweektraininginvolvingpracticalcommunication
skillsandroleplayingscenarios.Finally,theinterventionsfallingintothethirdcategoryofferedmu
lticomponentsolutions.3.3.StandalonetrainingOfthetwenty-
sixstudiesincludedinthisreview,10imple-
mentedstandalonetrainingsessions/workshopsfornursesinanefforttocounterworkplaceviol
ence.However,thestandaloneses-
sionsdidnotallfocusontargetingthesamecategoryofWPV.Outofthe10studies,fivewereintende
dtohelpcounterverbalandphysicalabuse[15,21,31,36,42],atypeofWPVwheretheprimaryperp
etratorsarepatientsandtheirrelatives.Onestudy[31]addressedsexualabuse,whichisprimarilyi
nflictedbymalepatientsandphysicians.Finally,theremainingstudiesfocusedonworkplaceaggr
ession[19],andworkplacebullying/incivility[16,26,37,42],typesofWPV,whichtendtobeperpet
ratedamongstaffmembersandbynursemanagers.Beyondthesedifferingpointsoffocus,thetrain
ingsessionsalsovariedinlength.Twostudiesassessedtheeffectivenessofathreetofourhourstrai
ningsessiontode-escalateviolence[19,41].Meanwhile,anotherstudyimplementedaneight-
Table1SelectedStudiesbasedonInclusionCriteriaandCriticalAppraisalDatabasesutilizedforse
archMEDLINECINAHLWebofScienceTotalAbstractsreviewedbyPrimaryInvestigatorn¼1944
n¼1206n¼1177n¼4327RelevantHitsn¼84n¼22n¼65n¼171Full-
textArticlesAssessedforEligibilityn¼16n¼10n¼17n¼43StudiesIncludedintheFinalReviewa
fterCriticalAppraisaln¼11n¼06n¼09n¼26R.Somanietal/InterventionstoDe-
escalateWorkplaceViolence291
hourtrainingprogramonviolenceprevention[36].Thesestudiesreportthat,asaresultofthestan
dalonetrainingsession,nursesweremoreconfidentintheirabilitytodealwithviolentsituations,a
ndtheirabilitytoassessviolentsituationsincreased[19,36,41].Onestudy[41]usedasimulationtr
ainingmethodandconcludedthatthetrainingincreasednurses’confidenceindealingwithworkp
laceincivility.ThestudyreportsthatWorkplaceCivilityIndex(WCI)scoresimprovedsignificantly
(p

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