What barriers to the effective implementation of tech prep programs

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OJIN is a peer-reviewed, online publication that addresses current topics affecting nursing practice, research, education, and the wider health care sector. Find Out More Benefit for Members Members have access to current topic More Reading their comments and experiences regarding their growth as an emerging NI leader highlighted to us the importance of proactive work to support the NI leadership pipeline.

Continue Reading View all Letters Vol20No01PPT01 Keywords: Workplace violence, workplace violence prevention, violence perception, program barriers, program effectiveness, reporting, bullying, customer service, accountability, profit-driven management, mentally ill Seven states have enacted laws to reduce WPV against healthcare workers by requiring workplace violence prevention programs. Review of the Literature It has been documented in the literature that nurses and allied health professionals are at an increased risk of workplace violence compared to other professionals.

Barriers to Reporting of WPV Events Underreporting of workplace violence is a well known barrier to effective implementation of WPV programs because the lack of reporting does not permit easy identification of trends and problem areas within the hospital Gallant-Roman, Research Methods and Analysis Our qualitative study utilized two focus groups to characterize perceptions and opinions of unionized nurses and allied health professionals regarding barriers to effective implementation of WPV prevention programs in hospitals.

Findings There were a total of 27 focus group participants, 13 in one focus group and 14 in the other group. Lack of action resulting from reporting Varying perceptions of what constitutes violence Bullying Impact of money and profit driven management models Lack of management accountability Intense focus of healthcare organizations on customer service Weak social service and law enforcement approaches to mentally ill patients Table 3.

Acknowledgement The authors would like to thank Toni Lombardi for conducting the initial coding of the focus groups transcripts in NVivo. References Adamson, M. Vol18No01Man04 Nachreiner, N. Follow Us on:. Job Description. Number of Participants.

Direct Patient Contact. Radiology Technician. Storeroom Clerk. Emergency Dept. Catheter Lab Nurse. Prison Nurse. Figure 2. Barriers The magnitude and complexity of this change, leadership instability, competing demands, resistance of one or more groups of stakeholders, scarce resources and various technical problems were the major barriers identified by respondents from the 71 NHs Figure 3.

Figure 3. Competing Demands The demands of additional major change initiatives occurring at the same time were reported to have made implementation difficult. Resistance to Change Resistance came from many directions and a variety of stakeholders. Scarce Resources Scarce resources were often cited as significant barriers to implementation. Technical Problems A great variety of technical problems were mentioned. Facilitators The champions reported a number of facilitators as well.

Persistence and Frequent Monitoring Champions often remarked that they had to continually work to change the mindset of the staff the essence of culture change. Unfolding Positive Results Positive results were not immediately apparent but when they did emerge, they reinforced the message and increased motivation to persist with implementation.

Frequencies and Percents The number and percent of NHs reporting which of these barriers and facilitators of change may be found in Figure 3. Turnover Successful change initiatives require consistency in staff, leadership and governance.

Interrelation Among Factors These barriers and facilitators are clearly interrelated, suggesting that one cannot concentrate on one or two of them but should take all of them into consideration when implementing a major change. Contributor Information Ruth M. References 1. The New England Journal of Medicine. Organizing for nursing home quality. Quality management in health care.

Makos J. What is pest analysis and why it's useful. Reaves EL, Musumeci M. Henry J. Kaiser Family Foundation; Dec 15, Medicaid and long-term services and supports: A primer. Stefanacci RG. Long-term care regulatory and practice changes: Impact on care, quality, and access. Allen JE. Nursing Home Administration. Wiener J. An assessment of strategies for improving quality of care in nursing homes.

Journal of the American Medical Directors Association. Health Services Research. Jarboe DE. Brief hospitalizations of elderly patients: a retrospective, observational study. Lewin K. New York: Harper; Burnes B. Journal of Management Studies. Schein EH. Reflections: The SoL Journal. An assessment of cultural values and resident-centered culture change in US nursing facilities. Health Care Management Review. Journal of Applied Gerontology. Journal of the American Geriatrics Society.

Lopez SH. Los Angeles, California: Sage Publishing; Perry A. Castle N, Lin M. Top management turnover and quality in nursing homes. Castle N. Administrator turnover and quality of care in nursing homes.

The Costs of Turnover in Nursing Homes. Medical Care. Castle NG, Engberg J. Cohen-Mansfield J. Nursing Management. Knapp M, Missiakoulis S. Predicting turnover rates among the staff of English and Welsh old people's homes. Support Center Support Center. External link. The 27 attendees of this meeting were divided into two, roughly equal-sized groups.

The first author JB , a trained facilitator, served as the group facilitator for the first group. The second and third authors MR and DH , who were also trained facilitators, served as facilitators for the second group. Each focus group lasted approximately two hours, for a total of four hours of discussion. No incentives were provided to the participants of the focus group sessions for their participation. The focus group facilitators utilized the same prompt sheet for each group to guide the discussion.

This prompt sheet was developed and reviewed both by the researchers conducting this study and by union representatives prior to use. The primary inputs used to develop the prompt sheet were prior studies that involved employee interviews about perceptions of violence Blando et al. Focus group facilitators allowed participants to express opinions that diverged from these three major areas if they were related to workplace violence; they only intervened when the length of time utilized by the participant was excessive.

This was designed to allow the researchers to capture important thoughts and opinions related to workplace violence in general terms. Transcripts were generated from the digitally recorded sessions and participants agreed to the recording both in the verbal informed consent procedures and with an additional confidential signed document collected by NIOSH attesting to release of their rights to the audio recording.

Handwritten notes were not taken by any of the focus group facilitators during the focus group sessions. Following these sessions, the digital audio recordings were converted into written transcripts and then coded by project staff. NVivo v10 QSR International, , a qualitative research software tool, was used to manage the coded themes that emerged from the collected interview data.

Any theme referenced by more than three participants was flagged for manual inspection and assessment. The transcript segments that corresponded to a flagged theme were then manually inspected by project staff. The research team categorized the identified flagged themes, which are discussed below.

There were a total of 27 focus group participants, 13 in one focus group and 14 in the other group. Almost all focus group participants worked in a hospital setting and had direct patient contact See Table 1. Nearly half of the participants worked day shift and the other half worked the evening or night shift.

The predominance of female workers in nursing is well established, as the United States U. Census Bureau, The participants also represented experienced workers, as all participants had practiced in their respective fields for at least several years. These participants were active in their New Jersey union and were very familiar with legislative and management-labor-relation issues.

The participants identified seven primary themes indicating major barriers to effective implementation of workplace violence prevention programs in hospital settings See Table 2. Focus group participants felt that each of these barriers presented significant impediments to effective workplace violence prevention programs. Table 3 lists specific quotes from participants that illustrate the individual themes identified in this analysis.

Previous studies have addressed WPV and offered recommendations for action. We will now discuss, in the above-listed order, the seven themes barriers our focus group participants have helped us to identify and then suggest strategies to overcome these barriers to WPV prevention.

Reporting is an important measure for addressing workplace violence; it allows the WPV prevention program to identify trends and problem areas within the hospital and to develop appropriate interventions to prevent WPV. However, the focus group participants overwhelmingly agreed that many healthcare providers believe that reporting is a waste of time because effective corrective actions do not result from their reports.

It is important that WPV prevention programs address and acknowledge reports received from employees, so employees know that the sharing of their concerns is valued and that management has an interest in correcting the reported concern. These effects are particularly relevant for healthcare workers because of the pace and intensity of their work activities.

If employees do not feel valued, or identify benefits to reporting, they will likely not report incidents of violence in the workplace. Blando and colleagues have suggested that staff development sessions be tailored to the healthcare specialty receiving the training. Focus group participants particularly emphasized that many nurses view the intent of the perpetrator as being key to whether they consider an act violent and also that personal circumstances and family situations factor into their decision regarding their reaction to violence See Table 3.

It has been recognized that bullying in all forms, both superior to subordinate vertical and nurse to nurse horizontal , has a high prevalence in the nursing profession Berry et al. The negative impact of bullying has also been demonstrated in relation to employee retention and productivity Berry et al. All employees have the potential to bully; however, St-Pierre and Holmes found that increasing influence and reducing accountability increases the risk of bullying. As a result, there must be a reporting system that holds all individuals, at any level in the structure of an organization, accountable.

Unfortunately, many focus group participants felt that their WPV prevention programs did not effectively address bullying at their healthcare facility.

These participants believed that people were not being held accountable and were allowed to continue to bully; employees that complained were labeled as trouble makers; hazing of new nurses was still considered acceptable; and many different and subtle ways of bullying were continuing in spite of organizational directives to the contrary See Table 3.

The influence of financial concerns and profit-driven-management models also significantly impacts the implementation of workplace violence prevention programs. Although lack of management accountability is an organizational issue, there are many opportunities to assure that all levels of an organization are accountable for their actions and decisions.

This may include employee representation on important hospital committees and within-agency, decision-making groups. Another effective way to demonstrate to employees that management is accountable is by partnering with the unions representing the employees. Focus group participants raised significant concerns that there did not appear to be a strong motivation within hospitals to assure that their program was effective as long as it complied with the New Jersey Violence Prevention in Healthcare Facilities Act regulations.

Communication of an expectation of acceptable behavior among employees, patients, visitors, and family members can enhance mutual respect for all people while not diminishing the quality of care offered in the healthcare organization. Focus group participants identified poorly funded social services and current law enforcement approaches to mentally ill patients as having a significant impact on their risk of workplace violence See Table 3.

Often, nurses and allied health staff become default caretakers and managers of patients with broader social problems as a result of poorly funded or ineffective social services. Participants highlighted the need for the hospital to partner and collaborate with social service organizations and law enforcement agencies to manage these high-risk populations.

Public policy makers need to recognize the deficiencies that exist in the mental health system and provide resources to effectively address this important public health problem. Concurrently, we are conducting a study of hospital security directors. Preliminary data demonstrate some similarities and differences in opinions compared to nurses. Presently, the data seem to indicate that hospital security directors are often former law enforcement officers who frequently are very sympathetic to the challenges faced by law enforcement and social services.

As a result, they are less likely to suggest the police should change their practices, which is in contrast to the nurses in this focus group who believed that law enforcement and social services should reconsider their practices. Security directors seem to take less issue with the emphasis on customer service in healthcare and accept it as the proper way to operate a healthcare facility, also in contrast to the nurses in this focus group.

Other barriers identified by our focus group nurses were similar to those shared by hospital security directors in this concurrent survey. This study had several limitations, including a lack of randomization among the focus group participants that could have resulted in reporting bias.

Although the numbers of participants were relatively low, the sampling was appropriate to qualitative methodology and participants were drawn from a variety of hospital professionals, enabling the participant selection process to support the aim of the study.

The length of the focus group sessions allowed significant exploration and explanation of ideas expressed. This qualitative study utilizing focus groups provided insights regarding the barriers to effective implementation of workplace violence prevention programs.