August 8, 2021
Abstract
This paper will research the impact of team coaching and simulator training to mitigate healthcare workplace violence. Healthcare employees are more likely to experience workplace violence (WPV) than any other profession. It continues to rise in the U.S. Healthcare providers experience patient violence due to various reasons such as altered mental status, agitation, or fear.
I searched various online library database for scholarly and peer-reviewed articles written after 2000. I included articles with disciplines related to healthcare (e.g., nursing, medicine, and psychology) and coaching. Papers selected address coaching and simulator training effectiveness and impacts on workforce behavior and outcomes.
Research supports that simulators and coaching reduce workplace violence prevention through hands-on training that provides the workforce with the knowledge, awareness, skills, and confidence to manage situations. Furthermore, simulation training followed by immediate coaching through debriefing effectively supports behaviors, techniques, outcomes, and healthier workplace culture.
Introduction
Healthcare employees are twenty times more likely to experience workplace violence (WPV) than any other profession. It continues to rise in the U.S. (Workplace Violence in Healthcare, 2018, n.d.). Healthcare providers experience patient violence due to various reasons such as altered mental status, agitation, or fear. Violence is often predictable due to escalating verbal or para verbal signs. Still, in some cases, it is not practical training that could reduce the significance of the injury. This critical literature review explores five articles to address three questions:
How does coaching and simulation training improve workforce behaviors and outcomes?
Are there typical coaching methods used in healthcare that are more effective?
Does the utilization of simulator training and team coaching have an impact on healthcare workplace violence?
This paper will introduce five articles that argue coaching and simulator training effectiveness. It reduces workplace violence prevention through hands-on training that provides the workforce with the knowledge, awareness, skills, and confidence to manage situations. The first argument will prove that coaching and simulator training provide antecedent skills to prevent an event from escalating and react effectively should the situation escalate towards verbal or physical violence. The second argument supports simulation training followed by immediate coaching through debriefing is effective in helping or modifying behaviors or techniques. Finally, the third argument utilizes research data to prove simulation and coaching improves workforce behaviors and outcomes.
Method
I conducted an electronic article search in Fielding Graduate University online library and Google Scholar search engines. I used seven keywords (healthcare, employee, perspective, simulation, coaching, safety climate, workplace violence) that resulted in several hundred results. Articles excluded were those written before 2000, as disciplines unrelated to healthcare (e.g., nursing, medicine, and psychology) and coaching. Twenty-one article abstracts were reviewed for relevance to support arguments for my question. Additional two papers were reviewed based on references from two article references. I examined eighteen articles to assess the selection method scope (Table 1) and research bias (see Tables 2 and 3). Of those with either good or great criteria, I selected five for this paper.
Research
Eppich and Cheng (2015) initiated a three-year mixed-methods multi-step research process at three hospitals in Canada. The research aimed to justify the need for a standardized debriefing framework, development of the framework, and simulation training on how to adapt the framework. The study resulted in the development of the “Promoting Excellence and Reflective Learning in Simulation” (PEARLS) coaching framework. There were no documented exclusions to the participants or surveys. The research identified a few practical guides and framework available; therefore, developing a new framework was necessary.
W. J. Eppich et al. (2016) provides a narrative assessment of a qualitative study they conducted at several hospitals in Canada and the East coast of the U.S. The article aimed to broaden the scope of and opportunities for additional debriefings as coaching conversations. The study found that participating in reoccurring simulation and coaching conversations contributes to healthier workplace culture.
Martinez (2017) conducted a pilot simulation study of fifteen undergraduate nurses enrolled in a psychiatric class at a public university in a large urban city on the west coast. The study aimed to enhance students’ knowledge about workplace violence, increase their confidence and ability to recognize signs of aggression, practice evidence-based interventions to de-escalate agitated patients, and evaluate the simulation. There were no documented exclusions to the participants or surveys. The study limitations include gender bias and student-teacher bias. A qualitative survey was developed just for this survey, and there was no control group.
Robson et al. (2012) assessed twenty-two Occupational Health and Safety (OHS) program literature research papers. The research studied simulation training benefits and effectiveness regarding staff’s knowledge, attitude, beliefs, and behaviors. The literary search excluded research that did not include data, was not published in peer-reviewed journals, or meet quality standards. In addition, the authors identified that the lack of studies, therefore, outcome data could be bias. The studies were conducted in different occupations and bundled together, impacting data specific to one industry.
Wong et al. (2015) conducted a study of one-hundred and sixty-two Emergency Department staff members consisting of medical residents, nurses, and police officers in a New York trauma hospital. The research was conducted over three months and aimed to 1) develop a multi-disciplinary training program, and 2) assess attitudes pre and post didactic training and simulation. The study utilized the Management of Aggression and Violence Attitude Scale (MAVAS) tool. Participants were excluded if they did not complete the pre/post-tests and all of the training. The study was limited by being a one-time mixed-methods study at one hospital.
Discussion
In the above five articles, simulator training was typically referenced as a realistic but safe venue to act out situations to address issues. Additionally, the articles utilized the word “coach” or “coaching” as one’s observations and perspectives on specific matters; it may involve confirming or challenging learners’ self-assessment of their performance by providing effective feedback and focused teaching; more directive (Eppich, 2016). To better understand simulator training and coaching effectiveness, I focused on 1) the impact of simulation training and coaching, 2) practical methods, and 3) results and impact on the participants.
Simulation Training and Coaching Impact
Simulation training is a highly utilized method in healthcare to provide skills-based hands-on training in a team approach. It provides close to real-life experiences in a safe environment allowing participants to play out scenarios as they would in real life. Robson (2012) reported that simulator training positively affects staff regarding knowledge, attitudes, and behaviors. Higher engaged (hands-on) workplace violence (WPV) training had a higher impact than lower engaged (classroom) training. Martinez (2017) pre and post-surveys after a WPV simulation training also showed a statistically significant confidence level that simulations increase participants’ knowledge, skills, and confidence.
Coaching during and after simulation events provides participants to reflect on their performance and opportunities for improvement. Typically, a debrief is conducted at the end of the simulation, asking open-ended questions regarding how participants felt about their performance and areas for improvement. Eppich (2016) utilized a standardized four-step debrief model: obtaining a reaction, description of the event, analyzed opportunities, and summarize the discussion. Healthcare coaches have also conducted “micro-briefings” in the middle of simulations to provide immediate coaching allowing participants to re-due the process. Standardization of debriefs and coaching response has also shown positive impacts on training.
Simulation-Coaching Methods
These articles addressed limited resources, tools, and a standardized framework surrounding WPV simulations and coaching. The studies also addressed limitations of experience and knowledge of coaches themselves. During a multi-year study, Eppich and Cheng (2015) developed a coaching tool called Promoting Excellence and Reflective Learning in Simulation (PEARLS). PEARLS framework consists of a standardized coaching script followed by questions. Regardless of the coach’s experience or skills, this standardized framework is thriving. The coach can select questions based on gaps addressing knowledge, skills, or behaviors. Both Eppich and Wong et al. (2015) articles reference David Klob’s Experimental Learning Theory as a starting point for their research. Eppich, Wong, and Klob support simulation training, aligned with a pragmatic coach to experiment with different responses to have the most significant impact.
Simulator Training and Coaching Impact
Standardized simulator training and use of a standardized debriefing tool by a coach have shown improvement to prepare healthcare workers against workplace violence, their response, and confidence levels. Martinez (2017) utilized the Mental Health Nursing Clinical Confidence Scale (MHNCCS) to measure impact. Wong et al. (2015) measured training impact using the Management of Aggression and Violence Attitude Scale (MAVAS). Some can argue that because clinicians are prepared and confident, they can handle the event, which will reduce events from occurring as they identify escalation behaviors and can react before it turns to violence. In essence, they can differentiate the “how” (to manage violent patient) to “why” (what is the patient needing to calm them down) and mitigate earlier. Unfortunately, the articles did not prove that the simulations and coaching mitigated future violent events.
Limitations
This paper is limited to reviewing five articles hyper-focused on research conducted in hospitals within the past two decades related to healthcare workplace violence, coaching, and simulation training. Three articles were mixed-methods studies with small study samples, one was a qualitative study, and one was a literature review. The research was conducted in hospitals focusing on workplace violence prevention training within different departments (ED, behavioral health, occupational safety). The articles identified limited standardization of simulation and coaching tools. Furthermore, research was focused on the impact of the workforce knowledge, behaviors, and attitudes of the workforce and not outcomes-based.
Further Research
This paper was not able to determine if simulation training and coaching impact the reduction of WPV events. Researchers should initiate additional research on intercultural sensitivity coaching to correlate simulation training and coaching impact hospital culture and WPV events.
Conclusion
Simulation and team coaching have proven successful in addressing staff knowledge, skills, behaviors, and confidence. Simulation training provides a safe environment for teams to respond to events and experiment with their responses. Coaching during the simulation debriefing offers a form of feedback and an adult learning educational environment. The coach poses open-ended questions allowing participants to reflect on their performance and feelings. At the same time, the team reflects and assesses their overall performance and opportunities to improve. This form of adult learning utilizes the pragmatist theory approach using qualitative and quantitative methods to measure improvement.
References
Bachkirova, T., Spence, G., & Drake, D. (2017). The SAGE Handbook of Coaching. 794.
Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 10(2), 106–115. https://doi.org/10.1097/SIH.0000000000000072
Eppich, W. J., Mullan, P. C., Brett-Fleegler, M., & Cheng, A. (2016). “Let's Talk About It": Translating Lessons From Health Care Simulation to Clinical Event Debriefings and Coaching Conversations. Clinical Pediatric Emergency Medicine, 17(3), 200–211. http://dx.doi.org.fgul.idm.oclc.org/10.1016/j.cpem.2016.07.001
Martinez, A. J. S. (2017). Implementing a Workplace Violence Simulation for Undergraduate Nursing Students: A Pilot Study. Journal of Psychosocial Nursing and Mental Health Services, 55(10), 39–44. https://doi.org/10.3928/02793695-20170818-04
Robson, L. S., Stephenson, C. M., Schulte, P. A., Amick, B. C., Irvin, E. L., Eggerth, D. E., Chan, S., Bielecky, A. R., Wang, A. M., Heidotting, T. L., Peters, R. H., Clarke, J. A., Cullen, K., Rotunda, C. J., & Grubb, P. L. (2012). A systematic review of the effectiveness of occupational health and safety training. Scandinavian Journal of Work, Environment & Health, 38(3), 193–208.
Wong, A., Wing, L., Weiss, B., & Gang, M. (2015). Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum. Western Journal of Emergency Medicine, 16(6), 859–865. https://doi.org/10.5811/westjem.2015.8.26220
Keywords: healthcare, employee, perspective, simulation, coaching, safety climate, workplace violence
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