Enhancing Health Care Personnel's Response to ER Violence Using Situational Simulation

Background: The emergency room (ER) has the highest rate of workplace violence among all departments in health care institutions. Workplace violence significantly affects the retention rate among health care professionals in the ER. Studies reveal that health care institutions find it extremely challenging to reduce ER violence and to protect their workers. This study aims to provide a means to prevent ER violence by designing simulation training based on clinical cases of ER violence. Method: Our study used a single pretest/posttest control group design, which focused on ERs from teaching hospitals in various districts of Taipei, Taiwan. A total of 34 participants who were working as physicians, registered nurses, security guards, and social workers participated. The study was based on Kolb's experiential learning theory and employed standardized patients to simulate clinical cases of ER violence in four stages of learning and evaluation effectiveness: (a) concrete experience, (b) reflective observation, (c) abstract conceptualization, and (d) active experimentation. Results: Health care personnel posttest scores and delayed posttest scores for self-efficacy as related to ER violence (Wald χ² = 85.202, p <.001) and to respond to ER violence (Wald χ² = 85.202, p <.001) significantly improved as compared to pretest levels. Conclusion(s): Situational simulation training, using standardized patients, has the potential to be an efficient effective response to ER violence. Training courses should be provided to personnel in the following four types of occupations: physicians, registered nurses, security guards, and social workers.