Violence towards emergency department nurses by patients

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Abstract

Emergency department (ED) violence is a significant problem in many hospitals. This study identified the incidence of violence by patients towards nurses in two EDs. Patient factors related to violence were identified and the circumstances surrounding the violent incident were described. Of the 71 ED nurses who participated, 50 (70%) reported 110 episodes of violence in a five-months period. That is approximately five violent incidents per week. Violence was reported most often on evening shifts (n=41, 37%). The nurses' perceived that the perpetrators of violence were under the influence of alcohol (n=30, 27%) and drugs (n=27, 25%) and displayed behaviours associated with mental illness (n=42, 38%). Nurses in this study were sworn at (n=67, 61%), pushed (n=11, 10%), hit (n=3, 3%), and kicked (n=3, 3%). Identification of trends and patterns of violence is necessary so that better health care planning and service provision as well as effective preventative and safe strategies for nurses in the workplace can be implemented.

Introduction

Violence is an occupational health and safety issue that all nurses face in their day-to-day activities. Australian Workers Compensation claims of registered nurses that involved violence were higher than that of police and prison officers (Perrone, 1999). Compensation claims from the health industry have increased 6.8% between 1992 and 1995 (WorkCover NSW, 1997). Emergency department (ED) nurses are said to experience some form of violence weekly (Lyneham, 2000). The plethora of literature related to hospital violence has predominantly focused on a range of issues related to changes in the skills and knowledge of staff, patient characteristics, as well as models of health care service delivery. The purpose of this study was to identify the incidence and characteristics of violence in the ED as reported by nurses.

Section snippets

Literature review

From a review of the literature, four aspects of violence in the ED are apparent and relate to how violence is defined, how it is reported, characteristics of patients committing the violence and organisational characteristics. Significantly, a standardised definition of workplace violence is not evident in the literature and various terms identified include assault, abuse, and aggression. A recent definition of violence used in an international study is “… an act that includes physical force

Method

A descriptive, longitudinal cohort design study was conducted in two public EDs in South East Queensland, Australia. Collectively, approximately 80,000 patients a year present for treatment. The university and participating hospital human ethics committees approved this study.

Results

A total of 108 nurses from two EDs were invited to participate in this study. Seventy-one (66%) nurses completed and returned the demographic details form, 50 (70%) of whom reported violence in the five months. Table 1 includes AIHW data to allow comparison between study data and Australian workforce statistics. It shows that the demographics of nurses participating in this study were similar to those of all nurses throughout Australia. The majority of ED nurses who reported violence were in

Discussion

Violence in hospitals is of concern both nationally and internationally. Front-line nurses, such as those in the ED, are often the targets of violence. The incidence of violence reported in this study is low when compared to retrospective studies (e.g. Lyneham, 2000). However, it did indicate that 50 of the 71 (70%) nurses participating during the five-months study period, reported violence. Perhaps this difference can be explained by under-reporting and other factors that attempt to identify

Recommendations

This study identified key issues, supported other research on violence towards ED nurses and provides a foundation for future work in the area. As a result of this study, recommendations for future research and practice have emerged that relate to enhancing the safety of nurses. These are summarised in Table 6.

Conclusion

Violence towards ED nurses by patients is perceived as a problem but reporting of incidents continues to be poor. Nurses must report violence to inform hospital administration as well as society of the extent and nature of the problem. Nurses in this study were pushed, slapped, kicked and sworn at by patients. Patient factors, such as long waiting times, alcohol, drugs and mental health issues were perceived by nurses to be related to violence. Most violent patients were triaged at category 3

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