Digital Repository Masters Projects Spring 2024 Assessing the Impact of Workplace Violence Prevention Programs on Medical-Surgical Hospital Nurses: A Six-Month Analysis of Incidence Reduction and Job Satisfaction Improvement Kaylie Sweat Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Sweat, K. 2024. Assessing the Impact of Workplace Violence Prevention Programs on Medical-Surgical Hospital Nurses: A Six-Month Analysis of Incidence Reduction and Job Satisfaction Improvement Weber State University Masters Projects. This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Assessing the Impact of Workplace Violence Prevention Programs on Medical-Surgical Hospital Nurses: A Six-Month Analysis of Incidence Reduction and Job Satisfaction Project Title by Kaylie Sweat Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY April 26, 2024 Ogden, UT Date Kaylie Sweat, BSN, RN, MSN Student 03/31/2024 Student Name, Credentials (electronic signature) Date 04/26/2024 MSN Project Faculty (electronic signature) Date 04/26/2024 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Assessing the Impact of Workplace Violence Prevention Programs on Medical-Surgical Hospital Nurses: A Six-Month Analysis of Incidence Reduction and Job Satisfaction Improvement Kaylie Sweat, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This project aims to assess the impact of implementing a workplace violence prevention program for medical-surgical hospital nurses to determine the effectiveness of a violence prevention program. Rationale/Background: Workplace violence in medical-surgical units poses significant challenges to both nurses' well-being and patient care quality. Existing literature highlights the prevalence of workplace violence in healthcare settings, with studies indicating high rates of verbal abuse and physical aggression against nurses. Despite increased awareness of this issue, effective interventions tailored to the unique needs of medical-surgical nurses are lacking. Methods: This project employed a multi-step approach to address workplace violence prevention in medical-surgical units. A comprehensive literature review guided evidence-based intervention development tailored to the specific needs of medical-surgical nurses. Pre- and posttraining assessments will measure the effectiveness of the interventions. Qualitative data collection will capture participant feedback and perceptions. Results: The project is anticipated to reduce workplace violence incidents among medicalsurgical nurses and adverse effects from violent incidents. Qualitative feedback from stakeholders will highlight the project's positive impact on nurses' understanding of workplace violence prevention strategies and their willingness to report incidents to enhance their safety and well-being. Conclusions: This paper addresses workplace violence prevention strategies in medical-surgical units by implementing evidence-based interventions. The findings highlight the critical role of organizational policy, nurse education, and interdisciplinary collaboration in addressing this widespread issue. 3 Keywords: workplace violence, medical-surgical units, training programs, safety measures, job satisfaction, prevention strategies 4 Assessing the Impact of Workplace Violence Prevention Programs on Medical-Surgical Hospital Nurses: A Six-Month Analysis of Incidence Reduction and Job Satisfaction Improvement This project is designed to address workplace violence against medical-surgical hospital nurses, specifically focusing on enhancing their safety and job satisfaction. Violence against nurses has been recognized as a hazard for many years, with the Joint Commission categorizing it as an occupational hazard in the early 1990s (Arnetz, 2022). The phenomena of violence and studies surrounding it have evolved over the years to include business, professional practices, and healthcare. Workplace violence poses a significant challenge in healthcare settings, particularly in medical-surgical units, where nurses are at heightened risk of encountering violence from patients and their families (Havaei et al., 2020). This project's importance lies in its potential to improve the quality of healthcare delivery by ensuring a safer and more satisfying work environment for nurses. By implementing effective workplace violence prevention programs, this project aims to contribute to the well-being of nursing professionals while safeguarding patient care quality. Workplace violence in medical-surgical hospital settings is a multifaceted issue characterized by physical and verbal abuse, harassment, and assaults, which can have profound consequences on nurses’ safety and job satisfaction (Mento et al., 2020). Research indicates that healthcare workers, including nurses, face a higher risk of workplace violence than employees in other sectors (Al‐Qadi, 2021). Despite widespread recognition of this problem, there remains a significant gap in understanding the effectiveness of prevention programs tailored to medicalsurgical nurses within a specific timeframe. It is crucial to investigate the magnitude of the 5 problem and its impact on nurses and to explore the potential benefits of implementing targeted prevention measures to address this gap. The current literature consistently underscores workplace violence’s prevalence and its detrimental effects on nurses. Studies by Dadfar and Lester (2021), Havaei et al. (2020), and Mento et al. (2020) have documented the heightened risk faced by healthcare workers, particularly nurses, in encountering violence incidents. Such incidents lead to physical injuries, emotional distress, and burnout among nurses, impacting their job satisfaction and well-being (Dadfar & Lester, 2021). Additionally, workplace violence contributes to staffing shortages, increased turnover rates, and potential compromises in patient safety and care quality (Kim et al., 2021). While the literature acknowledges the potential benefits of workplace violence prevention programs, their specific impact on reducing violence incidents and improving job satisfaction among medical-surgical hospital nurses remains an area requiring further empirical investigation. In the context of nursing leadership, addressing workplace violence takes on a rolespecific significance. Nurse leaders are essential in creating a safety culture and advocating for their nursing staff’s well-being (Havaei et al., 2020). In recognition of the impact of workplace violence on both nurses and patient care, nurse leaders need to be instrumental in championing initiatives to reduce violent incidents and enhance job satisfaction (Havaei et al., 2020). This project aligns with the leadership role of nurse managers, as it seeks to evaluate the effectiveness of workplace violence prevention programs and provides data-driven insights that can inform practice and policy changes. Nurse leaders can utilize the findings to implement evidence-based strategies, ensuring that their nursing teams work in safe, satisfying environments conducive to delivering high-quality care. 6 The project utilizes a structured framework for systematic program evaluation, ensuring a comprehensive process and identifying success factors and barriers. This approach guides evidence-based recommendations for practice and policy changes, effectively addressing workplace violence against medical-surgical hospital nurses. Statement of Problem Workplace violence against medical-surgical hospital nurses is a pressing clinical problem that profoundly affects the healthcare workforce and patient care quality (Havaei et al., 2020; Somani et al., 2021). This issue is characterized by physical and verbal abuse, harassment, and even assault, predominantly from patients and their families (Bernardes et al., 2021; Mento et al., 2020; Mobaraki et al., 2020). The problem is well-documented in the literature, with numerous studies and reports underscoring its pervasive nature and detrimental consequences. During the early 1990s, researchers started revealing the prevalence and impact workplace violence has within the healthcare setting (Al‐Qadi, 2021). Studies and increased awareness have contributed to its continuous presence within the literature, emphasizing the importance of addressing workplace violence. Healthcare workers, particularly nurses, are at a heightened risk of encountering violent incidents within the hospital (Al-Qadi, 2021; Lim et al., 2022; Somani et al., 2021). The prevalence of this problem is substantial, as evidenced by data from the Occupational Safety and Health Administration (OSHA) indicating that healthcare and social assistance workers have the most significant risk of workplace violence, with healthcare workers accounting for a quarter of all workplace violence (as cited in Lim et al., 2022). Al-Qadi (2021) stated that 17.9% of nurses leave their jobs due to workplace violence. The impact of workplace violence on medical-surgical hospital nurses is significant. It results in physical injuries, emotional distress, and burnout among nursing staff (Al-Qadi, 2021; 7 Dadfar & Lester, 2021; Havaei et al., 2020; Kafle et al., 2022; Lim et al., 2022). Such adverse outcomes have substantial implications for the job satisfaction of nurses, with potential consequences such as increased turnover rates (Kim et al., 2021). Moreover, the problem extends beyond the individual nurse to impact patient care quality. When nurses experience violence in the workplace, it can affect overall job performance and contribute to staffing shortages, compromising the safety and quality of care delivered to patients (Kim et al., 2021). This project aims to address this critical issue by evaluating the effectiveness of workplace violence prevention programs, with the intended outcomes of reducing violent incidents towards nurses and enhancing their job satisfaction within six months. By systematically investigating this problem and its potential solutions, the project seeks to contribute to developing evidence-based strategies and policies that can create safer and more satisfying work environments for medicalsurgical hospital nurses. Significance of the Project This project holds substantial importance as it directly addresses the pervasive issue of workplace violence against medical-surgical hospital nurses, offering a significant contribution to this critical area of focus. It is evident from extensive literature (Al-Qadi, 2021; Lim et al., 2022; Mento et al., 2020; Somani et al., 2021) that workplace violence is a persistent problem affecting healthcare workers, particularly nurses, who are highly vulnerable. However, a significant knowledge gap exists in understanding the effectiveness of targeted prevention programs tailored to medical-surgical nurses within specific timeframes. This project bridges this gap, building on and complementing previous work by systematically evaluating the impact of these programs. Doing so aims to provide empirical evidence and data-driven insights that can shape evidence-based strategies and policies to mitigate workplace violence. The potential 8 benefits extend to various stakeholders, including patients who will receive care in a safer environment, students who can learn in a more secure clinical setting, managers and nurse leaders who can advocate for evidence-based practices, nurses who can experience improved job satisfaction and well-being, and the healthcare setting, which can foster a culture of safety and quality care (Havaei et al., 2020). This project, therefore, aims to make a substantial difference by advancing the understanding of effective violence prevention measures and their potential to enhance the healthcare environment for all involved. With the PICOT question defined and the groundwork for research set in the introduction, the following section shifts its focus to an indepth literature review to explore existing studies, theories, and findings related to workplace violence prevention programs for medical-surgical hospital nurses. Review of the Literature A literature review explored the current evidence related to workplace violence prevention programs for medical-surgical hospital nurses. Various types of research and nonresearch evidence were reviewed and analyzed. Additionally, evidence-based change frameworks were assessed to determine the most suitable framework for guiding the implementation of workplace violence prevention programs in medical-surgical hospital settings. The Stages of Change Theory was chosen as the framework to plan and execute evidence-based changes associated with this project. The Stages of Change Theory was selected due to its focus on behavior change, providing a structured approach to evaluating the impact of a workplace violence prevention program on nurses' experiences and job satisfaction within a six-month timeframe. This theory allows for a more personalized, longitudinal assessment, considering psychological and emotional factors relevant to nurses' well-being. 9 Framework The Stages of Change Theory, also known as the Transtheoretical Model (TTM), is a well-established framework for understanding and facilitating health behavior change. This model outlines individuals' stages when contemplating and making behavioral changes (Hashemzadeh et al., 2019). These stages include pre-contemplation, contemplation, preparation, action, and maintenance, with some variations incorporating a termination stage. Each stage represents a different readiness level and willingness to change, making it crucial to tailor interventions accordingly (Raihan & Cogburn, 2023). Hashemzadeh et al. (2019), in their systematic review of the Transtheoretical Model, provide valuable insights into its applications across diverse health contexts, shedding light on its effectiveness and adaptability. The initial pre-contemplation stage is characterized by individuals who lack awareness of the need for change or may be in denial about it. Often, these individuals need more information regarding the risks associated with their current behavior (Raihan & Cogburn, 2023). Interventions in the pre-contemplation stage primarily aim to raise awareness and provide essential information (Hashemzadeh et al., 2019), enabling individuals to recognize the need for change. In contemplation, individuals acknowledge the need for change but may exhibit ambivalence or uncertainty about taking action (Raihan & Cogburn, 2023). During this phase, they weigh the pros and cons of change, necessitating interventions that address their ambivalence while highlighting the benefits of change (Hashemzadeh et al., 2019). The preparation stage involves active planning for change, with individuals setting specific goals and developing actionable plans. Here, interventions should support individuals in creating concrete plans and addressing potential barriers (Hashemzadeh et al., 2019). Subsequently, the action stage sees individuals taking measurable steps toward behavioral change, with interventions 10 focusing on providing support, encouragement, and strategies to maintain progress (Raihan & Cogburn, 2023). Finally, the maintenance stage follows the action stage, with individuals striving to sustain their new behavior over the long term. Interventions in the maintenance stage are geared toward helping individuals maintain their newly adopted behavior. By tailoring interventions to an individual's specific stage, healthcare professionals can effectively facilitate health behavior change (Hashemzadeh et al., 2019). Applying the Stages of Change Theory (TTM) to implementing a workplace violence prevention program for medical-surgical hospital nurses can be elucidated. In the precontemplation stage, administrators and nurses may not fully grasp the extent of workplace violence or the potential benefits of a prevention program, necessitating interventions to raise awareness through data on violence prevalence and program advantages (Hashemzadeh et al., 2019). A comprehensive plan for program implementation is developed while progressing to the contemplation and preparation stages, involving input from nurses and addressing their concerns to enhance their job satisfaction (Hashemzadeh et al., 2019). Subsequently, the "Action" stage involves program implementation with tailored support for nurses, encompassing training, reporting mechanisms, and continuous monitoring, while the maintenance stage ensures program longevity through regular evaluations and adjustments, thereby reducing violence incidence and improving job satisfaction (Hashemzadeh et al., 2019; Raihan & Cogburn, 2023). In essence, the Stages of Change Theory guides the structured implementation of the prevention program, aligning with the evolving readiness of nurses and administrators to foster a safer and more satisfying work environment. 11 Strengths and Limitations The Stages of Change Theory provides a strong structure for interventions to promote changes in health behaviors. Its individual-centered approach acknowledges varying readiness levels for change and allows tailored interventions to enhance effectiveness. Furthermore, the model's recognition of the non-linear nature of behavior change aligns well with real-world complexities, allowing for adjustments as individuals move through different stages (Hashemzadeh et al., 2019). However, the TTM's potential oversimplification of the change process, as highlighted by Hashemzadeh et al. (2019), may need to fully capture the intricate factors influencing behavior change in healthcare contexts. Additionally, the reliance on selfreport data is a limitation that requires careful consideration, especially when objective measures are critical in healthcare assessments (Raihan & Cogburn, 2023). Therefore, while the Stages of Change Theory offers valuable strengths for health behavior change interventions, its limitations necessitate thoughtful adaptation and supplementation to ensure its effectiveness in promoting behavior change in healthcare settings (Hashemzadeh et al., 2019; Raihan & Cogburn, 2023). The Stages of Change Theory offers a valuable framework for implementing workplace violence prevention programs within healthcare organizations, as illustrated in Hashemzadeh et al.'s (2019) systematic review. In the pre-contemplation stage, healthcare institutions unaware of the issue can benefit from interventions raising awareness about workplace violence's prevalence and potential consequences. In the contemplation and preparation stages, organizations acknowledging the problem can explore program options and develop implementation plans, aligning with the TTM's recognition of readiness levels (Hashemzadeh et al., 2019). The action stage involves program rollout and employee engagement, ensuring that recommended practices are adopted effectively. Finally, the maintenance stage, emphasized by Hashemzadeh et al., 12 involves ongoing evaluation and adjustment to sustain program effectiveness, ultimately fostering safer work environments for healthcare professionals. Analysis of Literature A rigorous literature review was completed to explore the topic of workplace violence among medical-surgical nurses. Three major themes were identified to support the MSN project PICOT question: Does implementing a workplace violence prevention program for medical-surgical hospital nurses, compared to hospitals without such programs, lead to a reduction in the incidence of violence towards nurses and an improvement in nurses' job satisfaction within six months? The first theme identified was the prevalence and characteristics of workplace violence against nurses (Al‐Qadi, 2021; Bernardes et al., 2021; Chakraborty et al., 2022; Dehghan-Chaloshtari & Ghodousi, 2020; Ramzi et al., 2022; Yesilbas & Baykal et al., 2021). The second theme focused on the impact of workplace violence on nurses and the healthcare system (Byon et al., 2022; Hsu et al., 2022; Kim et al., 2021). The third theme identified in the literature centered on strategies for preventing and addressing workplace violence (Baig et al., 2018; Havaei et al., 2020; Kafle et al., 2022; Ming et al., 2019; Shane Escue et al., 2023; Somani et al., 2021). Search Strategies A comprehensive search strategy was employed to identify current evidence for the literature review on workplace violence among nurses. Multiple reputable databases and search engines were utilized, including CINAHL, Ovid, PubMed, and Weber State University's OneSearch. These sources were chosen for their extensive coverage of healthcare and nursingrelated literature. Only articles published within the last five years, from 2018 through 2023, 13 were included to maintain the review's relevance and currency. This time frame allowed the focus to remain on recent developments and insights in the field. The search terms and keywords were thoughtfully selected to align with the clinical question, which revolves around workplace violence among nurses. Key phrases such as "nurse abuse," "consequences of workplace violence," "de-escalation interventions," "workplace violence training," "hospital violence," and "prevalence of workplace violence" were incorporated. Boolean operators, such as "AND" and "OR," enabled the creation of comprehensive search strings, combining relevant keywords to refine and broaden the search scope. Filters were applied during the search process to ensure that only peer-reviewed research papers were considered. This step added an extra layer of credibility and reliability to the sources included in the review. Limiting the search to articles published within the specified time frame ensured a focused exploration of recent evidence, aligning with the goals of the literature review. Synthesis of the Literature The literature analysis revealed three central themes of prevalence and characteristics of workplace violence, its effects on healthcare professionals, and the strategies and approaches for its prevention and management. These overarching themes encompass the key trends and insights derived from the existing literature on workplace violence among healthcare professionals, providing a comprehensive understanding of the issue's nature, its impact on the well-being of professionals, and the diverse array of strategies devised for its prevention and resolution. Prevalence and Nature of Workplace Violence The prevalence and nature of workplace violence among healthcare professionals have been extensively explored in the research literature (Al-Qadi, 2021; Bernardes et al., 2021; 14 Chakraborty et al., 2022; Dadfar & Lester, 2021; Ramzi et al., 2022; Yesilbas & Baykal, 2021). Numerous studies have delved into the multifaceted aspects of this issue, shedding light on its prevalence, contributing factors, and associated challenges. These findings collectively provide a comprehensive understanding of the nature of workplace violence in healthcare settings. Al-Qadi (2021) provided a concept analysis of workplace violence in nursing, offering fundamental insights into the nature and components of this issue. The concept analysis reveals that workplace violence encompasses a range of behaviors, including verbal abuse, physical violence, and intimidation, demonstrating the issue's complexity (Al-Qadi, 2021). Bernardes et al. (2021) examined the experiences of nursing professionals, which adds to the depth of understanding of how violence manifests in healthcare settings. Bernardes (2021) found that many nursing professionals experienced workplace violence, with verbal abuse being the most common form. Dadfar and Lester (2021) examine the nature of workplace violence in healthcare and its implications. Dadfar and Lester's (2021) findings emphasize that workplace violence in healthcare is characterized by a lack of reporting and awareness, which speaks to its hidden nature. In a systematic literature review conducted by Chakraborty et al. (2022), violence against physicians and nurses is explored in depth. Chakraborty et al. (2022) discovered that the prevalence of workplace violence against healthcare professionals is a global concern. These acts include physical violence, verbal abuse, and sexual harassment. This information reinforces the widespread nature of workplace violence and its varying forms. Yesilbas and Baykal (2021) conducted a qualitative study investigating the causes of workplace violence against nurses. This research offers insights into the nature of workplace violence, particularly its origins and contributing factors. Yesilbas and Baykal found that the nature of workplace violence against nurses was often rooted in patient dissatisfaction, 15 miscommunication, and unmet expectations, shedding light on the complex interplay of factors contributing to this issue. In a systematic review and meta-analysis, Ramzi et al. (2022) investigated the prevalence of workplace violence against healthcare workers, including nurses. Ramzi et al. (2022) revealed a high prevalence of workplace violence against healthcare workers during the COVID-19 pandemic. The nature of this violence ranged from physical assault to verbal abuse, highlighting the severity and breadth of the issue. The research conducted collectively illuminates the comprehensive nature of workplace violence in healthcare settings, encompassing various forms of abuse and a wide range of contributing factors (Al-Qadi, 2021; Bernardes et al., 2021; Chakraborty et al., 2022; Dadfar & Lester, 2021; Ramzi et al., 2022; Yesilbas & Baykal, 2021). Impact on Healthcare Professionals Workplace violence against healthcare professionals is a critical issue that significantly impacts their well-being and job satisfaction. Recent studies have illuminated various aspects of this issue, exploring the emotional and practical consequences on healthcare professionals (Byon et al., 2022; Hsu et al., 2022; Kim et al., 2021). Byon et al. (2022) delved into nurses' experiences with type II workplace violence, especially during the challenging period of the COVID-19 pandemic. Their findings revealed the unique challenges healthcare professionals faced during this time, such as heightened stress and increased incidents of violence from patients or visitors. Moreover, the study highlighted the prevalent underreporting issue, suggesting that workplace violence against healthcare professionals may be considerably higher than reported (Byon et al., 2022). Hsu et al. (2022) conducted qualitative research that delved into the dilemmas and repercussions of workplace violence against emergency nurses, offering a comprehensive 16 understanding of the emotional and practical impact experienced by these healthcare professionals. This study emphasized the challenges faced by emergency nurses as a result of workplace violence, particularly highlighting their frequent encounters with emotional exhaustion. Given that emergency nurses work in inherently high-stress environments, the emotional toll of workplace violence poses significant concerns for their well-being and job satisfaction (Hsu et al., 2022). Kim et al. (2021) explored the interconnectedness between workplace violence, emotional exhaustion, and patient safety. The study provided valuable insights into workplace violence's impact on healthcare professionals' emotional well-being. This emotional exhaustion can, in turn, affect the quality of patient care, potentially jeopardizing patient safety (Kim et al., 2021). Recent studies have shed light on the multifaceted nature of this problem, emphasizing the emotional and practical toll it takes on healthcare workers (Byon et al., 2022; Hsu et al., 2022; Kim et al., 2021). Prevention and Intervention Strategies Effective prevention and intervention strategies are crucial in addressing workplace violence and its impact on healthcare professionals (Baig et al., 2018; Ming et al., 2019; Somani et al., 2021; Shane Escue et al., 2023). The study by Baig et al. (2018) examined the effectiveness of training programs designed to de-escalate violence and manage aggressive behavior encountered by healthcare providers. Their research showed that these training programs significantly enhanced the skills of healthcare workers in handling workplace violence effectively, emphasizing the value of well-structured training in empowering healthcare professionals. Ming et al. (2019) employed simulation-based training as an intervention strategy to prepare nurses to deal with workplace violence effectively. Their research demonstrated that 17 simulation training considerably improved nurses' capabilities in responding to violent situations, highlighting the importance of preparedness and practice in managing these incidents. Somani et al. (2021) conducted a systematic review to assess the effectiveness of various interventions to de-escalate workplace violence against nurses. While specific findings were not detailed here, the study provided a comprehensive review that likely highlighted diverse strategies and approaches for effectively addressing this issue, underscoring the importance of a multifaceted approach to interventions. Shane Escue et al. (2023) provide insight into implementing effective interventions against workplace violence in healthcare settings. Engaging all the stakeholders in problem-solving and continuously improving the interventions showed improvement in decreasing workplace violence. Practical training, simulation exercises, and well-implemented interventions emerge as essential components of a comprehensive approach to mitigating the impact of workplace violence on healthcare workers (Baig et al., 2018; Ming et al., 2019; Somani et al., 2021; Shane Escue et al., 2023). Summary of Literature Review Findings and Application to the Project The reviewed literature offers valuable insights into the challenges faced by healthcare professionals regarding workplace violence. It highlighted that workplace violence is a widespread concern in healthcare settings, affecting the well-being and job satisfaction of healthcare professionals (Al-Qadi, 2021; Bernardes et al., 2021; Chakraborty et al., 2022; Dadfar & Lester, 2021; Ramzi et al., 2022; Yesilbas & Baykal, 2021). The literature suggests that workplace violence encompasses various forms, including verbal abuse, physical violence, and intimidation, emphasizing its complex nature (Al-Qadi, 2021). Moreover, the studies revealed that the prevalence of workplace violence is a global concern, with healthcare professionals experiencing physical violence, verbal abuse, and sexual harassment (Chakraborty et al., 2022). 18 Understanding its nature, contributing factors, and associated challenges is crucial to address this issue effectively. The literature contributes to the proposed solution by shedding light on workplace violence's origins and contributing factors, including patient dissatisfaction, miscommunication, and unmet expectations (Yesilbas & Baykal, 2021). This comprehensive understanding of workplace violence will inform the development of targeted interventions and educational programs to prevent and de-escalate workplace violence in healthcare settings. Project Plan and Implementation This fundamental section presents a comprehensive plan to decrease workplace violence directed toward medical-surgical hospital nurses, specifically emphasizing enhancing their safety and job satisfaction. The aim is to provide a tailored strategy for the unique dynamics within the healthcare systems by building upon the insights gathered from the literature review. This plan considers medical-surgical nurses' multifaceted challenges and outlines key steps for reducing workplace violence incidents while enhancing job satisfaction. The strategy encompasses targeted training, leadership engagement, communication protocols, and continuous evaluation. By aligning with the identified recipients—medical-surgical nurses, nurse managers, and healthcare administrators—the plan seeks to bridge the gap between existing knowledge and practical interventions, fostering a safer and more satisfying work environment. Plan and Implementation Process This MSN project endeavors to influence medical-surgical nurses, nurse managers, and hospital administrations in addressing workplace violence against medical-surgical hospital nurses. The specific focus lies in tailoring interventions to enhance safety and job satisfaction for nurses within the targeted healthcare institution. The implementation plan thoroughly addresses the multifaceted nature of workplace violence in medical-surgical units by drawing insights from 19 the literature review. Key components encompass tailored training programs, active engagement of nurse leaders, transparent communication channels, and an ongoing evaluation framework. The primary beneficiaries of this initiative are medical-surgical nurses, nurse managers, and healthcare administrators, all crucial players in fostering a safer and more satisfying work environment. The plan is intricately crafted to align with the dynamics of the healthcare system, recognizing the unique challenges tied to patient care complexities, diverse shift patterns, and the potential for escalated workplace violence risks. By contextualizing the strategy within this specific healthcare environment, the objective is to create a lasting impact that addresses workplace violence and improves the overall well-being of medical-surgical nurses in hospital settings. Interdisciplinary Team In addressing workplace violence against medical-surgical hospital nurses, a collaborative and multidisciplinary approach involving various healthcare professionals is imperative for the successful implementation of proposed interventions. Interdisciplinary teamwork, encompassing medical-surgical nurses, nurse educators, nurse unit managers, nurse preceptors, new graduate nurses, hospital security officers, and hospital administrators, is crucial to achieving common goals and enhancing patient care outcomes (Dadfar & Lester, 2021; Kafle et al., 2022; Somani et al., 2021). This collaborative framework is vital when initiating systemic changes to mitigate workplace violence. Medical-Surgical Nurses. Medical-surgical nurses are directly impacted by workplace violence because they are frontline caregivers. Their active participation in the project is crucial for providing insights into their challenges and ensuring that interventions align with their needs. 20 Nurse Educators. Focused primarily on nurse educators working within medicalsurgical units, these professionals contribute to the project by designing educational content, facilitating training sessions, and assessing the progress of nursing staff. Their role is pivotal in translating educational needs into tailored plans and interventions for medical-surgical nurses. Their unique understanding of academic content and learners’ needs contribute to the knowledge gained for the medical-surgical unit nurses. Nurse Unit Managers. Nurse unit managers play a central role in hospital administration and are vital for the approval and implementation of the project. Their expertise in planning process steps, considering budgetary requirements, and addressing policy or legal constraints is essential. Nurse managers also have experience with events, such as violence in the facility against any nurses, which can contribute to the educational needs of nurses on a particular unit. Nurse Preceptors. Operating on the frontline where clinical rotations occur, nurse preceptors guide and mentor new nurses during rotations. Their experience is invaluable for the project's success, and their feedback is crucial for ongoing improvements in the program. Nurse preceptors work with new graduate nurses who will actively participate in the project. New graduate nurses provide essential feedback based on their experiences during the yearlong residency program. Their insights contribute to comprehensively examining the project's effectiveness in improving job satisfaction. Hospital Security Officers. The security officers’ primary role is to ensure the safety and security of healthcare facilities. Experiences fulfilling this role bring a unique perspective to the project. Collaborating with this group is crucial for implementing measures to prevent and address workplace violence incidents. Hospital security can provide insight into workplace violence events to which they have responded and recommendations for changes. 21 Hospital Administrators. As leaders within the healthcare institution, hospital administrators provide overarching support for the project. Their involvement is crucial in securing resources, aligning the project with organizational goals, and fostering a culture that prioritizes the safety and well-being of healthcare professionals. Hospital administrators also have training and experience in bringing groups together for a common goal. This group will be an essential aspect of the project. By bringing together the diverse expertise, knowledge, and skills of medical-surgical nurses, nurse educators, nurse unit managers, nurse preceptors, new graduate nurses, hospital security officers, and hospital administrators, the collaborative teamwork approach ensures a comprehensive strategy to address workplace violence. This multidisciplinary effort is poised to positively impact patient care outcomes and create a safer and more satisfying work environment for healthcare professionals. Description and Development of Project Deliverables The project's deliverables encompass materials to address workplace violence against medical-surgical nurses. The Workplace Violence Prevention in Medical-Surgical Nurses Pamphlet serves as an educational resource, providing quick insight into the challenges faced by medical-surgical nurses, risk factors associated with workplace violence, and the potential consequences of such incidents (see Appendix A). The pamphlet also outlines key training details and projected outcomes for the overall project. With a focus on briefness and clarity, this pamphlet offers a prompt overview of the project's goals and the specific nursing population it aims to support. Additional modules will be developed to address the need for education in the workplace violence prevention project. These modules will complement the existing pamphlet and the continued development of training sessions, providing in-depth education on 22 recognizing, responding to, and preventing workplace violence incidents. The pamphlet will be tailored to medical-surgical nurses' specific needs and challenges to enhance their knowledge and skills in effectively managing workplace violence situations. The Medical-Surgical Nurse Workplace Safety and Well-being Survey is designed to assess the experiences, perceptions, and needs of medical-surgical nurses concerning workplace violence (see Appendix B). Minor alterations to the pre-survey will create the post-survey. The survey poses targeted questions designed to elicit insights from participants, covering aspects such as the prevalence and nature of workplace violence incidents encountered, the reporting of such incidents, the impact on job satisfaction, perceptions of existing prevention measures, confidence in handling violent situations, and the adequacy of training received. The survey will be slightly altered as a post-training survey to assess knowledge retention from the training. The alterations to the survey include omitting questions one, two, three, six, and eight. Question four will be reworded to “How many times have you reported incidences of workplace violence?” This comprehensive approach ensures an understanding of the challenges faced by medicalsurgical nurses and provides a foundation for evidence-based interventions. The Consequences of Workplace Violence Infographic visually presents the multifaceted impact of workplace violence on nurses, including physical and emotional trauma, burnout, job dissatisfaction, and compromised patient care (see Appendix C). These deliverables collectively contribute to a comprehensive and evidence-based approach to workplace violence prevention, addressing medical-surgical nurses' unique challenges. The Workplace Violence Prevention Training PowerPoint is a training module on workplace violence prevention for medical-surgical nurses (see Appendix D). It covers essential topics such as the prevalence and consequences of workplace violence, risk factors, de-escalation 23 techniques, reporting procedures, support resources, and organizational policies and procedures. The PowerPoint is an educational tool for training and preparing nurses to address workplace violence situations. This deliverable will be utilized during the training sessions provided to the medical-surgical nurses. Timeline A comprehensive timeline will facilitate the efficient execution of this project (see Appendix E). The projected timeline unfolds with initial planning during the first two phases, defining project objectives and forming an interdisciplinary team for diverse input. The literature review and needs assessment phase fosters a profound understanding of workplace violence challenges through a comprehensive literature review. The subsequent four phases are dedicated to developing project deliverables, such as the pamphlet, survey, and infographic. These are meticulously crafted to resonate with medical-surgical nurses and align with the project's objectives. The following three phases emphasize educational interventions, culminating in a training session encompassing the administration of the Medical-Surgical Nurse Workplace Safety and Well-being survey. Simultaneously, the distribution of pamphlets will occur during training sessions, and the Workplace Violence Consequences infographic will find its place in breakrooms, promoting heightened awareness. The subsequent phases delve into data analysis of the previous four phases as an analysis of survey responses gathered during the training, facilitating the identification of insights, patterns, and trends among medical-surgical nurses. Concluding the timeline, the final phase is to disclose the project findings. Stakeholders will receive detailed reports, with an additional emphasis on evaluating the understanding and concerns of medical-surgical nurses. 24 The proposed timeline outlines the critical phases for implementing the workplace violence prevention project among medical-surgical nurses. By strategically planning and organizing tasks, the project aims to enhance safety, well-being, and job satisfaction, addressing the multifaceted challenges associated with workplace violence in healthcare settings. The visual representation (see Appendix E) provides a clear overview of the project's trajectory, ensuring effective coordination and successful outcomes for the targeted nursing population. Project Evaluation In evaluating the effectiveness of the project, both formative and summative methods will be employed to comprehensively assess its impact on addressing workplace violence among medical-surgical nurses. Formative evaluation will involve ongoing monitoring and feedback throughout the project implementation process. Regular assessments will analyze medicalsurgical nurses' satisfaction with the training and educational resources. During their quarter check-ins, medical-surgical nurse managers will evaluate the nurses' thoughts and perceptions on the program's quality, and during stakeholder meetings, managers will present the feedback. Following assessments, adjustments will be made based on the nurse's input. Interviews will also be conducted, and focus group discussions will be held to gain deeper insights into participants' experiences and gather suggestions for improvement. This continuous feedback loop will help ensure that the interventions are effective and responsive to nurses' needs. For summative evaluation, several outcome measures will assess the project's effectiveness in reducing workplace violence and improving safety and well-being among medical-surgical nurses. Pre- and post-surveys will measure changes in participants' knowledge, attitudes, and behaviors related to workplace violence prevention and management. The presurvey will be administered at the beginning of the training session, whereas the post-survey will 25 follow the completion of the online modules. Quantitative data on workplace violence incidents and related outcomes, such as injury rates and absences, will also be collected from hospital records before and after the project implementation. These summative methods will provide a comprehensive evaluation of the project's impact on addressing workplace violence and improving the overall work environment for medical-surgical nurses. Ethical Considerations Ethical considerations are vital to ensure the integrity and well-being of all involved, including participants and stakeholders. The project's focus on addressing workplace violence among medical-surgical nurses aligns with the principles of social responsibility, as it seeks to alleviate harm and improve the working conditions of medical-surgical nurses. By prioritizing nurses' safety and job satisfaction, the project reflects a commitment to non-discriminative behaviors, acknowledging medical-surgical nurses’ diverse backgrounds and experiences. The project will uphold respect and autonomy regarding participant treatment, ensuring that individuals can participate voluntarily and without coercion. Implemented measures will protect the privacy and confidentiality of participants, including obtaining informed consent and collecting data anonymously during evaluations and surveys. Individuals who choose not to participate will not face any repercussions, and their decisions will be respected. The project aims to adhere to ethical guidelines and standards throughout its implementation, fostering a culture of honesty, integrity, and inclusivity. By upholding these principles, the project seeks to address workplace violence and promote a supportive and respectful work environment for medical-surgical nurses. In planning activities or education sessions that may potentially evoke past traumas in nurses, it is crucial to prioritize psychological safety and create a safe and supportive environment. One approach is to provide advance notice 26 or trigger warnings about sensitive topics that may arise during the session, allowing individuals to prepare themselves and feel comfortable to step out if needed. Additionally, incorporating trauma-informed practices into the session design can help ensure facilitators know the potential impact of their words and actions on participants. Offering opportunities for debriefing, self-care strategies, and access to support resources during and after the session can also help mitigate any distress experienced by participants. Acknowledging and proactively addressing the possibility of triggering past traumas promotes a more compassionate and inclusive learning experience for all participants. Discussion This final section offers a brief overview of the key points discussed throughout the paper, emphasizing the implications of implementing the proposed change in addressing workplace violence among medical-surgical nurses. Recommendations for future initiatives will be provided, focusing on areas for further research and potential improvements to existing interventions. This section underscores the importance of ongoing efforts to enhance workplace safety and well-being for nurses, highlighting the significance of collaborative action and continuous evaluation in addressing this critical issue. Evidence-based Solutions for Dissemination After implementing the workplace violence prevention project, data will be collected through surveys distributed to medical-surgical nurses. These surveys will assess the nurses' perceptions of safety and job satisfaction before and after the project's implementation. The survey results will be compared with national benchmarks for workplace violence and job satisfaction among nurses. Findings will be shared with stakeholders through presentations at nursing staff meetings and email communication. Additionally, significant results will be 27 compiled into a report for potential publication in academic journals, aiming to contribute to the body of knowledge on workplace violence prevention in healthcare settings. Significance to Advance Nursing Practice Implementing the workplace violence prevention project holds significant potential to benefit the nursing profession in several ways. Firstly, by addressing the prevalent issue of workplace violence against nurses, this project can contribute to fostering a safer and more supportive work environment within healthcare settings. Research indicates that workplace violence not only adversely affects nurses' physical and psychological well-being but also leads to decreased job satisfaction and increased turnover rates (Havaei et al., 2020; Kim et al., 2021; Lim et al., 2022). By effectively addressing workplace violence through targeted interventions and educational initiatives, nurses are more likely to experience greater job satisfaction and retention rates, subsequently enhancing the overall sustainability of the nursing workforce (Baig et al., 2018; Ming et al., 2019; Shane Escue et al., 2023; Somani et al., 2021). Furthermore, as frontline healthcare providers, nurses play a crucial role in delivering quality patient care, and a safer work environment enables them to fulfill their professional duties more effectively, ultimately improving patient outcomes and overall healthcare quality (Al-Qadi, 2021; Havaei et al., 2020; Mobaraki et al., 2020). Therefore, addressing workplace violence through this project safeguards the well-being of nurses and contributes to elevating the standards of care delivery and strengthening the nursing profession. Implications While this project utilized many resources to create an effective plan, it is crucial to acknowledge its potential to significantly impact the profession positively, as well as changes to improve. The project has an interdisciplinary approach involving stakeholders such as medical- 28 surgical nurses, nurse educators, unit managers, security, and administrators. This collaborative effort ensures diverse perspectives and enhances the project's overall effectiveness. Additionally, applying evidence-based interventions and educational strategies from the literature review strengthens the project's credibility and potential for success. Limitations may include resource constraints, such as time and funding, which could affect the scope and scale of the project. Careful planning, prioritization of critical objectives, and leveraging existing resources within the healthcare institution will be essential to mitigate this obstacle. Resistance from critical stakeholders, including nursing staff and administrators, could hinder the project's progress and implementation. Overcoming this challenge will require effective communication, stakeholder engagement, and ongoing support to address concerns. While this project presents significant potential to impact the nursing profession positively, inherent limitations must be acknowledged. However, through collaborative efforts, evidencebased strategies, and proactive planning, the project aims to overcome these obstacles and improve workplace safety and well-being for medical-surgical nurses. Recommendations It is essential to consider ongoing evaluation and refinement of the project to ensure continual effectiveness. Over the next six months, this process will involve soliciting stakeholder feedback, conducting follow-up surveys, and monitoring workplace violence incidents. Expanding the project's reach to different units within the facility and other facilities will also enhance its impact on nursing. Conclusions In conclusion, the comprehensive literature review has shed light on workplace violence among medical-surgical nurses. Through a thorough examination of existing research, valuable 29 insights into the prevalence, risk factors, and consequences of workplace violence in healthcare settings have been presented (Al-Qadi, 2021; Bernardes et al., 2021; Dehghan-Chaloshtari & Ghodousi, 2020; Havaei et al., 2020; Kim et al., 2021; Lim et al., 2022). By engaging in collaborative efforts with healthcare stakeholders, including nurses, administrators, educators, and security personnel, the development and implementation of effective interventions are aimed at reducing workplace violence and promoting a culture of safety and respect (Baig et al., 2018; Ming et al., 2019; Shane Escue et al., 2023; Somani et al., 2021). However, it is essential to acknowledge the limitations of this project, including resource constraints and potential resistance from stakeholders. Future research should focus on evaluating the long-term effectiveness of these interventions and exploring additional strategies to address the multifaceted challenges of workplace violence in healthcare. Overall, this project represents a significant step forward in the collective efforts to create safer and more supportive work environments for medical-surgical nurses. 30 References Al‐Qadi, M. M. (2021). Workplace violence in nursing: A concept analysis. Journal of Occupational Health, 63(1), Article e12226-n/a. https://doi.org/10.1002/13489585.12226 Arnetz, J. E. (2022). The joint commission's new and revised workplace violence prevention standards for hospitals: A major step forward toward improved quality and safety. Joint Commission Journal on Quality and Patient Safety, 48(4), 241245. https://doi.org/10.1016/j.jcjq.2022.02.001 Baig, L., Tanzil, S., Shaikh, S., Hashmi, I., Khan, M. A., & Polkowski, M. (2018). Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in public sector hospitals of Karachi. Pakistan Journal of Medical Sciences, 34(2), 294-299. https://doi.org/10.12669/pjms.342.14432 Bernardes, M. L. G., Karino, M. E., Martins, J. T., Okubo, C. V. C., Galdino, M. J. Q., & Moreira, A. A. O. (2021). Workplace violence among nursing professionals. Revista brasileira de medicina do trabalho: publicacao oficial da Associacao Nacional de Medicina do Trabalho-ANAMT, 18(3), 250–257. https://doi.org/10.47626/1679-44352020-531 Byon, H. D., Sagherian, K., Kim, Y., Lipscomb, J., Crandall, M., & Steege, L. (2022). Nurses' experience with type II workplace violence and underreporting during the COVID-19 pandemic. Workplace Health & Safety, Article 21650799211031233. https://doi.org/10.1177/21650799211031233 31 Chakraborty, S., Mashreky, S. R., & Dalal, K. (2022). Violence against physicians and nurses: A systematic literature review. Journal of Public Health, 30(8), 18371855. https://doi.org/10.1007/s10389-021-01689-6 Dadfar, M., & Lester, D. (2021). Workplace violence (WPV) in healthcare systems. Nursing Open, 8(2), 527-528. https://doi.org/10.1002/nop2.713 Dehghan-Chaloshtari, S., & Ghodousi, A. (2020). Factors and characteristics of workplace violence against nurses: A study in Iran. Journal of Interpersonal Violence, 35(1-2), pp. 496–509. https://doi.org/10.1177/0886260516683175 Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian Journal of Nursing and Midwifery Research, 24(2), 83-90. https://doi.org/10.4103/ijnmr.IJNMR_94_17 Havaei, F., Astivia, O. L. O., & MacPhee, M. (2020). The impact of workplace violence on medical-surgical nurses’ health outcome: A moderated mediation model of work environment conditions and burnout using secondary data. International Journal of Nursing Studies, p. 109, 103666–103666. https://doi.org/10.1016/j.ijnurstu.2020.103666 Hsu, M., Chou, M., & Ouyang, W. (2022). Dilemmas and repercussions of workplace violence against emergency nurses: A qualitative study. International Journal of Environmental Research and Public Health, 19(5), Article 2661. https://doi.org/10.3390/ijerph19052661 Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review. Journal of Clinical and Translational Research, 8(5), 421–424. https://doi.org/10.18053/jctres.08.202205.010 32 Kim, S., Mayer, C., & Jones, C. B. (2021). Relationships between nurses' experiences of workplace violence, emotional exhaustion, and patient safety. Journal of Research in Nursing, 26(1-2), 35–46. https://doi.org/10.1177/1744987120960200 Lim, M. C., Jeffree, M. S., Saupin, S. S., Giloi, N., & Lukman, K. A. (2022). Workplace violence in healthcare settings: The risk factors, implications, and collaborative preventive measures. Annals of Medicine and Surgery, 78, 103727103727. https://doi.org/10.1016/j.amsu.2022.103727 Mento, C., Silvestri, M. C., Bruno, A., Muscatello, M. R. A., Cedro, C., Pandolfo, G., & Zoccali, R. A. (2020). Workplace violence against healthcare professionals: A systematic review. Aggression and Violent Behavior, 51, 18. https://doi.org/10.1016/j.avb.2020.101381 Ming, J., Huang, H., Hung, S., Chang, C., Hsu, Y., Tzeng, Y., Huang, H., & Hsu, T. (2019). Using simulation training to promote nurses' effective handling of workplace violence: A quasi-experimental study. International Journal of Environmental Research and Public Health, 16(19), Article 3648. https://doi.org/10.3390/ijerph16193648 Mobaraki, A., Aladah, R., Alahmadi, R., Almuzini, T., & Sharif, L. (2020). Prevalence of workplace violence against nurses working in hospitals: A literature review. American Journal of Nursing Science. 9(2), 84-90. 10.11648/j.ajns.20200902.19. Raihan, N., & Cogburn, M. (2023). Stages of Change Theory. [Updated 2023 Mar 6]. In StatPearls. StatPearls Publishing. Retrieved Oct 2, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK556005/ Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta- 33 analysis. Frontiers in Psychology, 13, 896156896156. https://doi.org/10.3389/fpsyg.2022.896156 Shane Escue, J., Gutierrez, F., Rebecca Batts, J., Lumagui, M., & Oloan, V. (2023). Implementing effective interventions against workplace violence. Critical Care Nursing Quarterly, 46(3), 255-270. https://doi.org/10.1097/CNQ.0000000000000457 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), 289295. https://doi.org/10.1016/j.shaw.2021.04.004 Yesilbas, H., & Baykal, U. (2021). Causes of workplace violence against nurses from patients and their relatives: A qualitative study. Applied Nursing Research, 62, 151490151490. https://doi.org/10.1016/j.apnr.2021.151490 34 Appendix A Workplace Violence Prevention in Medical-Surgical Nurses Pamphlet 35 36 Appendix B Medical-Surgical Nurse Workplace Safety and Well-being Survey https://forms.gle/48eyUxEjmoLpdgvj7 37 38 Appendix C Consequences of Workplace Violence Infographic 39 Appendix D Workplace Violence Training for Nurses PowerPoint 40 41 42 43 44 45 46 47 Appendix E Timeline Project Implementation Timeline Phase Initial Planning Timeline Weeks 1-2 Literature Review and Needs Assessment Weeks 3-6 Development of Project Materials Weeks 7-10 Educational Interventions Weeks 11-14 Data Analysis Weeks 14-19 Tasks Completed The project objectives and goals will be defined to ensure its effectiveness. An interdisciplinary team will be formed to ensure diverse input from various experts. A comprehensive literature review on workplace violence will be conducted, which will foster a deep understanding among staff about existing challenges. Deliverables, such as pamphlets, surveys, and infographics, will be created that resonate with medicalsurgical nurses and the project's objective. A training session will be provided where the MedicalSurgical Nurse Workplace Safety and Well-being Survey will be administered. The pamphlets will also be distributed at the training sessions. The Workplace Violence Prevention Training PowerPoint will be utilized during this training. The Workplace Violence Consequences infographic will be posted in the breakroom to promote awareness. The survey responses gathered during the training will be analyzed. The responses will allow for the identification of insights, 48 Dissemination Weeks 20-23 patterns, and trends with medical-surgical nurses. The project findings will be shared with the stakeholders through reports, and the medical-surgical nurses' understanding and concerns will be evaluated.