Nursing management of emergency department violence—Can we do more?

Abstract

Background: Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified. Aims:To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved.Design: A position paper underpinned by experiences and evidence reported in the literature.Methods: A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention.Conclusions: However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times.Relevance to Clinical Practice: More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

“I think we still do too little”: measures to prevent violence and aggression in German emergency departments – a qualitative study

“…There are further implications regarding the general structure of the healthcare system to combat high workloads due to patient influx. In general, concepts to target overcrowding and exit-blocks need to be implemented, since previous research identified overcrowding as a main risk factor for violence in EDs [ 32 ]. This requires cooperations with different hospital wards, psychiatric institutions, and nursing homes in order to transfer patients on time.…”

Reducing Violence in Riyadh’s Emergency Departments: The Critical Role of Healthcare Providers

“…Several researchers have investigated the extent to which the experience of violent events at work may increase the chances of burnout, including fear, anger, and depression [ 1 , 6 , 20 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] A recent study found that non-physical violence, mainly verbal aggression, was associated with emotional exhaustion, cynicism, and reduced professional efficacy [ 15 ]. Likewise, the participants in our study agreed that the assault had an emotional or physical impact on them, and it also impacted patients’ treatment and care.…”

Promoting holistic approaches to management of violence in the ED—a response to Ramacciati (2023)

“…We were very pleased to receive a response to our paper (Timmins et al, 2023) that highlighted current issues in relation to the nursing management of emergency department (ED) violence (Ramacciati, 2023). Moreover that the position paper achieved its primary aim in terms of “excellently achieved its goal of stimulating reflection on the causal factors of violence against nurses in emergency departments and discussing possible solutions and strategies for largely unresolved issues” (Ramacciati, 2023). This was most heartening for us.…”

“…In fact, ED nurses, when they are asked about triggers for ED violence state overwhelmingly that the environment is the major contributory factor (Angland et al, 2014). Ramacciati (2023) points out that the prevention and management of ED violence has been high on policy makers agendas for more than two decades, and yet the health services appear stifled in their success with operationalising these and reducing and addressing the issues. There are many reasons for this, including under‐reporting, acceptance of ED violence as part of the job and nurses only seeking redress when real harm has been done (Timmins et al, 2023).…”

“…Ramacciati (2023) points out that the prevention and management of ED violence has been high on policy makers agendas for more than two decades, and yet the health services appear stifled in their success with operationalising these and reducing and addressing the issues. There are many reasons for this, including under‐reporting, acceptance of ED violence as part of the job and nurses only seeking redress when real harm has been done (Timmins et al, 2023). However, Ramacciati (2023) reminds us that it is time to evoke considered action and begin to examine and address this phenomenon in a way that comprehensively considers the multifactorial contributors within the ED dynamic and one that fully supports both nurses and clients in their care.…”