Workplace violence (WPV) perpetrated by patients against healthcare staff is abundant in healthcare settings. Many interpersonal communication skills trainings have attempted to equip staff to be better able to de-escalate patient aggression and prevent WPV. Nurses have received the most attention in trainings, as opposed to other types of healthcare staff. However, previous research has found that WPV is most likely to occur in the first hour of a patient visit meaning that the frontline staff should be of focus, and have not been to this point. Experiencing WPV has important consequences for staff and for patients. For staff, experiencing WPV is associated with staff burnout, low self-efficacy, low patient cooperation, low job satisfaction, more stress at work, more absent days, and higher turnover. For patients, the implications of poorly managed interactions are grave. They will experience poor care including but not limited to restraint use, seclusion, or antipsychotic drug use. Skills trainings have been insufficient and have been largely atheoretical. This dissertation ultimately aims to decrease WPV by developing a better training for healthcare staff generally.
To achieve this decrease, a first step was to conduct a pilot study by interviewing approximately 30 staff members in Australia about what training they receive about WPV and who typically perpetrates WPV. Study 1 then completes an interpersonal skills training intervention and three-month follow-up mixed-methods survey with approximately 180 frontline staff in a Central California hospital. Third, and of most focus, Study 2 of this dissertation develops and tests a communication competence training to prevent WPV framed by Communication Accommodation Theory using longitudinal mixed methods surveys. Study 2 trained all staff at a Central California clinic (approx. 170 employees) including dental staff, frontline staff, administrative staff, and primary care staff.
Although experiences of WPV were quite low at pre-training for both populations in Study 1 and Study 2, results of this dissertation show that attitudes and approach to patient aggression are the strongest predictors of use of communication strategies and successful de-escalation. Overwhelmingly, those that are more understanding of patient aggression and make external attributions for patient aggression are much more likely to use competent communication and achieve de-escalation. As more staff are successful in de-escalation by holding positive attitudes and using competent accommodation, the more they impact organizational norms by encouraging others to do the same. The trainings in both Study 1 and Study 2 were successful insofar as they increased staff efficacy in managing patient aggression and increased patient cooperation. The training in Study 2 is the first de-escalation training to be theory driven and is therefore replicable across contexts. Results of Study 2 help to refine CAT in two ways, first by refining its principles, and second by showing the applicability of the theory to function in creating successful interventions that can lessen WPV and therefore positively impact healthcare contexts.