An evaluation of violence prevention education in healthcare

Background: An issue of international concern, violence towards healthcare workers from patients and visitors negatively affects the safety and health of workers and the quality of care they deliver. The principal intervention to address violence has been violence prevention (VP) educational programs for healthcare workers. Evaluating the overall effectiveness of VP education has been difficult due to pervasive underreporting of incidents, the complexity of healthcare settings, and the varying reasons for violence.Methods: A theory-driven, realist evaluation was conducted to examine the conditions under which VP education is effectively learned and applied in emergency department (ED) settings. Nine research sites included three rural, three community and three urban, tertiary care hospital EDs. Data from individual and focus group in-terviews with 136 participants was used to test a program theory (PT) of why and how VP education works, for whom, under what circumstances.Results: The initial program theory of VP education was based on a realist literature review and input from content experts. Qualitative data from the evaluation refined the initial program theory, yielding 15 explanations for how and why educational and workplace contexts influence ED workers' learning and application of VP knowledge and skills-ultimately reducing the risk of violence. While the explanations result from individual worker's perspectives of VP education, they are situated in a broader context of organizational safety climate including organizational leaders' response to employees' experiences with violence and feelings of physical and psychosocial safety.Conclusions: This research provides practical evidence for healthcare stakeholders to inform education, policy and practice decisions to increase the VP education effectiveness.