To address this gap, learner experiences and needs related to WPV were identified, lecture material and situational trigger films related to WPV were created, and immersion simulation experiences were developed. This bundle of activities led to the implementation of a dynamic pedagogical strategy that addressed all domains of learning: cognitive, psychomotor, and affective (Bloom, 1956). Trigger films are short films that are used to engage the affective domain (Molloy, Sabol, Silva, & Guimond, 2016). Immersion simulation experiences are widely used throughout modern nursing curricula to teach decision-making and psychomotor skill development through replication of patient scenarios in a safe environment (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). While the use of trigger films alone or the use of immersion simulations alone can be effective, when coupling the two strategies in a controlled environment, the learning effect may be enhanced.
This presentation will detail the authors’ experiences in conducting the needs assessment and designing the pedagogical interventions aimed at increasing students’ understanding around patient/visitor-perpetrated violence and best-practice prevention and mitigation strategies. Such interventions recognized the existing typology of workplace violence and integrated conceptual models applied to violence prevention. As such, they served as an effective approach to prepare future nurses to recognize and respond to one of the more well-documented occupational hazards facing health care workers today.
Needs Assessment. The needs assessment involved self-administration of an anonymous, brief (<5 minute) survey of pre-licensure students. The survey tool was used in a completed CDC/NIOSH R01 (Pompeii et al., 2016; Pompeii et al., 2015; Schoenfisch et al., 2015) and edited to reflect the target population. The definition of violence included physical assault, physical threat, and verbal aggression. Participants were asked to provide information about their demographics, work history, clinical requirements, and experiences of patient/visitor-perpetrated violence. An open-ended question sought concerns and recommendations to improve occupational safety and health for nursing students. Data were collected in REDCap (Harris et al., 2009), and statistical analyses were conducted in SAS (SAS Institute, 2014).
The survey was completed by 58 pre-licensure students. Most were female (84%), in their first year of the program (81%), and less than 35 years old (88%). More than forty percent (43%) had some kind of paid work experience in a health care setting (e.g., as a nursing assistant), and nearly all (98%) had experience in the clinical setting as part of their curriculum requirements. Overall, 28% of pre-licensure students experienced at least one episode of patient/visitor-perpetrated violence in the past 12 months as part of paid work in healthcare or during a nursing program clinical experience. Half of these events (50%) were verbal in nature; the other half included a physical threat and/or physical assault. Over one-third (38%) of pre-licensure students had thought of changing careers as a result of patient/visitor-perpetrated violence. WPV prevention training was recommended by participants including: training with various occupational groups involved in responding to violent events (e.g., nursing, security), de-escalation training, resiliency training, and simulation-based training.
Didactic Teaching. In the first-semester course “Health and Wellness Across the Lifespan,” a lecture was presented (n=142 students), covering the topics of occupational safety and health (including WPV) among nurses, with attention paid to the epidemiology of the problem, key players (e.g., federal and state agencies, accrediting bodies, professional organizations), and current WPV prevention approaches.
Trigger Film and Immersion Simulation. Students attended a 10-minute pre-brief in which they met the involved faculty and content experts and learned about the film and simulation process. Then, small groups of students (n=5-6/group) viewed the one-minute trigger film depicting a patient-perpetrated violent event. The film was tailored to local needs and the student population by faculty and other content experts after review of the literature and available materials from national and international organizations (e.g., Crisis Prevention Institute, National Institute for Occupational Safety and Health). Immediately after viewing the film, a behavioral health expert facilitated an 8 to 10-minute debriefing period for students to share their emotional response to the scenario. Students then transitioned to a 10-minute immersion simulation in which they were confronted with an escalating situation including a (script-led) verbally aggressive hospitalized patient, played by a student volunteer; a second student volunteer served as the caregiver. The simulation provided an opportunity to engage in de-escalating techniques and was followed by a 15-minute small group debrief with content experts.
A pre-test and post-test was administered to evaluate changes in students’ knowledge related to WPV surrounding the trigger film and immersion simulation. A majority of students “strongly agreed” that after participation they were able to “recognize behaviors of an escalating family member or patient” (65%), “discuss how to maintain personal safety in an escalating situation (75%), and “identify aspects of the clinical environment they may impact the safety of the workplace staff” (64%). Students conveyed general satisfaction with the addition of WPV content into their course work, with emphasis on its conduct in a simulated, safe environment and the inclusion of content experts. They also offered suggestions on how to improve the trigger film/simulation.
Details surrounding the needs assessment, content development, implementation of the intervention, pre-/post-test results, and lessons learned will be shared during the presentation. Conference attendees also will be invited to engage in a discussion about implementing this strategy in their own academic settings as a way to prepare students for future clinical practice. Materials will be made available to conference attendees upon request.