Community meetings: A strategy that works
Violence declines with staff-patient meetings
The risk of violence simmers in behavioral health units across the country — but it is possible to defuse that tension and prevent incidents through frequent "community meetings" between staff and patients.
That model of discussions about workplace violence has stood the test of time since it was first developed more than 10 years ago, says its creator, Marilyn Lanza, DNSC, CS, FAAN, a nurse researcher at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA.
"I don’t feel there should be any psych units that don’t have something like this," says Lanza.
She began with regular community meetings focused on violence prevention in a small unit at the Bedford hospital. Violent incidents declined by about 80%. "There was a tremendous difference in the assault rate," she says.
Lanza then took a more structured approach and tested the intervention at 13 VA hospitals. The Violence Prevention Community Meetings were held for a half-hour three times a week — twice on the day shift and once on the night shift. They were led by a mental health professional and all unit staff and patients participated.
This was the opportunity for both staff and patients to air their concerns, discuss incidents of violence and consider ways to prevent violence.
In the three weeks before implementation, there was an average of 4.7 violent episodes. During the nine-week pilot test, that decreased to an average of 0.73 — an 85% reduction.
Each session begins with a reminder for everyone to speak and listen respectfully, and to voice their concerns and ideas about workplace violence. They may discuss recent behavioral issues, prevention strategies and available resources. A typical meeting might include 35 patients and about 15 staff members, including psychiatrists, psychiatric interns and nursing students, says Lanza.
Management support is essential — as is consistency, says Lanza. The meetings must be regular and frequent to be effective, she says. In the study, violent incidents rose when the meetings were halted and decreased again when they resumed.
The Violence Prevention Community Meetings raise awareness of the problem and give everyone a voice in solutions, she says. Staff members appreciate the chance to share their feelings about incidents, she says. "Sometimes they’re surprised that their own reactions are important," Lanza says.
[Editor’s note: More information about Violence Prevention Community Meetings is available at www.innovations.ahrq.gov/content.aspx?id=3016.]
