A qualitative meta-synthesis of emergency department staff experiences of violence and aggression

Ashton, Rebecca Angharad; Morris, Leon; Smith, Ian

doi:10.1016/j.ienj.2017.12.004

Cited by 78 publications

(93 citation statements)

References 41 publications

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“…This meta-analysis has added some newly important findings compared with previous seven reviews and meta-analyses [13][14][15][16][17][18][19] in several important aspects. The number of included original studies, study perspective, and the scope and depth of study were different from the previous reviews.…”

Section: Discussionmentioning

confidence: 94%

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Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis

et al. 2019

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We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I2 statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.

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Section: Discussionmentioning

confidence: 94%

“…Previous reviews have tended to focus on one particular group of healthcare workers (eg, doctors, nurses or emergency medical service personnel only) and/or specific types of WPV (such as verbal, physical violence or sexual harassment only). 13 14 In addition, the existing reviews 15 16 have not used quantitative techniques to compute the…”

Section: Introductionmentioning

confidence: 99%

Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis

et al. 2019

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“…This included the provision of comfortable beds13 and items such as clothing,19 blankets, toilets, food and drink 25. In particular, nurses who were attentive to a patient’s basic physical needs were seen as providing a positive experience 25…”

Section: Resultsmentioning

confidence: 99%

“…Approaches to meta-synthesis include meta-ethnography and thematic synthesis 11 12. Meta-synthesis has been employed to enhance understanding of a range of issues in emergency care such as staff experiences of aggression and violence,13 perceptions of people who self-harm14 and delay in seeking treatment for myocardial infarction among female patients 15…”

Section: Introductionmentioning

confidence: 99%

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

et al. 2019

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BackgroundPatient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both quantitative and qualitative approaches can be used to evaluate patient experience in the emergency department (ED), the latter is well aligned to develop a detailed understanding of features influencing the lived experience of ED patients. This study aimed to systematically review the literature of qualitative studies to identify determinants of adult patient experience in the ED.MethodsA Preferred Reporting Items for Systematic review and Meta-Analysis compliant systematic review was conducted using PubMed, CINAHL, EMBASE, BNI and bibliography searches to identify qualitative studies exploring patient experiences in ED published in English between 1997 and 2018. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Descriptive text and quotations relating to patient experience were extracted from included studies and a meta-synthesis conducted using thematic analysis.ResultsA total of 625 records were screened from which 40 studies underwent full review and 22 were included. Results were coded by two researchers (BG and JML). Meta-synthesis identified 198 discrete units of analysis which were clustered around five analytical themes. These were based on the perceived ‘needs’ of patients visiting the ED and were defined as communication, emotional, competent care, physical/environmental and waiting needs. Findings were translated into a conceptual model for optimising patient experience in the ED.ConclusionThis meta-synthesis provides a framework for understanding the determinants of patient experience in the ED. The resulting conceptual model and recommendations may have the potential to directly inform practice and improve the patient experience.

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“…Indeed, experiences of patient violence are common for UK National Health Services (NHS) and other treatment staff (e.g., emergency departments) (Ashton et al, 2018;Price et al, 2015), potentially leading to negative views of patients and feelings of isolation in dealing with patient aggression. Patient suicide and self-harm also occur at raised levels in secure psychiatric hospital settings (Stewart et al, 2012).…”

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confidence: 99%

Coping, mental health, and subjective well-being among mental health staff working in secure forensic psychiatric settings: Results from a workplace health assessment.

Cramer

Ireland

Hartley

et al. 2020

Psychological Services

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Given raised rates of patient suicide and violence in secure psychiatric facilities, staff in such settings are arguably at increased risk for burnout and reduced mental health. The present paper responds to the recent UK National Institute for Health and Care Excellence (NICE) call to assess workforce well-being. This paper held the following aims: (1) to quantify existing levels of mental health (i.e., depression, anxiety, distress, and post-traumatic stress) and subjective well-being (i.e., job satisfaction, life satisfaction, and four domains of burnout), and (2) to evaluate Coping Self-Efficacy (CSE) and Need for Affect (NFA) as factors associated with staff mental health and subjective well-being. We conducted a voluntary crosssectional health needs assessment of forensic mental health staff (N=170) between 2017 and 2018 from one National Health Service (NHS) Trust. Descriptive findings suggest staff possessed non-clinical average ranges of mental health symptoms. Subjective well-being findings showed burnout was relatively low, whereas job and life satisfaction were modest. Regression models demonstrated that: (a) thought/emotion stopping beliefs were negatively associated with psychological exhaustion; (b) social support beliefs were positively associated with life satisfaction and job enthusiasm; (c) NFA Avoidance was linked with poor mental health and burnout, and; (d) NFA Approach was positively associated with two health subjective well-being indicators. Overall, assessment results suggest NHS forensic mental health staff reported relatively good health. Cognitive-and emotion-focused coping beliefs demonstrate promise as content for prevention programming. Using Emotional Labour Theory, we offer psychological services-based recommendations for future prevention programming and research.

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A qualitative meta-synthesis of emergency department staff experiences of violence and aggression

Abstract: Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff. A strong organisational commitment to reducing violence and aggression is imperative.

Cited by 78 publications

References 41 publications

Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis

Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis

‘They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department

Coping, mental health, and subjective well-being among mental health staff working in secure forensic psychiatric settings: Results from a workplace health assessment.

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