Personnel exposure to violence in hospital emergency wards: a routine activity approach

Utilization and effects of security technologies in mental health: A scoping review

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

Effects of verbal violence on job satisfaction, work engagement and the mediating role of emotional exhaustion among healthcare workers: a cross-sectional survey conducted in Chinese tertiary public hospitals

OBJECTIVE

Recently, Chinese ministries and commissions have issued a series of policies and systems in response to violent injuries to doctors, physical violence have been managed to a certain extent. However, verbal violence has not been deterred and is still prevalent, it has not received appropriate attention. This study thus aimed to assess the impact of verbal violence on the organisational level and identify its risk factors among healthcare workers, so as to provide practical methods for verbal violence reduction and treatment of the complete period.

METHODS

Six tertiary public hospitals were selected in three provinces (cities) in China. After excluding physical and sexual violence, a total of 1567 remaining samples were included in this study. Descriptive, univariate, Pearson correlation and mediated regression analyses were employed to assess the difference between the variables, emotional responses of healthcare workers to verbal violence and the relationship between verbal violence and emotional exhaustion, job satisfaction, and work engagement.

RESULTS

Nearly half of the healthcare workers in China's tertiary public hospitals experienced verbal violence last year. Healthcare workers who experienced verbal violence had strong emotional response. The exposure of healthcare workers to verbal violence significantly positively predicted the emotional exhaustion (r=0.20, p<0.01), significantly negatively predicted job satisfaction (r=-0.17, p<0.01) and work engagement (r=-0.18, p<0.01), but was not associated with turnover intention. Emotional exhaustion partially mediated the effects of verbal violence on job satisfaction and work engagement.

CONCLUSIONS

The results indicate that the incidence of workplace verbal violence in tertiary public hospitals in China is high and cannot be ignored. This study is to demonstrate the organisational-level impact of verbal violence experienced by healthcare workers and to propose training solutions to help healthcare workers reduce the frequency and mitigate the impact of verbal violence.

Violence against nurses by patients and visitors in the emergency department: A concept analysis

AIM

This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures.

BACKGROUND

Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff.

METHODS

This study employed Walker and Avant's concept analysis technique.

RESULTS

The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm.

CONCLUSION

A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.

Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards

BACKGROUND

Most existing research on medical clowns in health care services has investigated their usefulness mainly among child health consumers. In this research we examined multiple viewpoints of medical staff, clowns, and health consumers aiming to identify the optimal audience (adult or child health consumers) for which medical clowns are most useful. We focused on exploring their usefulness in enhancing health consumers' satisfaction and, in turn, reducing their aggressive tendencies.

METHODS

We conducted three studies that examined the placement fit of medical clowns from different points of view: medical staff (Study 1, n = 88), medical clowns (Study 2, n = 20), and health consumers (Study 3, n = 397). The main analyses in Studies 1 and 2 included frequencies and t-tests comparing perceived adult and child satisfaction with clowns' performance. Study 3 used moderated-mediation PROCESS bootstrapping regression analysis to test the indirect effect of negative affectivity on aggressive tendencies via satisfaction. Exposure to the medical clown moderated this relationship differently for different ages.

RESULTS

Studies 1 and 2 show that the majority of medical clowns and medical staff report that the current placement of the medical clowns is in pediatric wards; about half (44% of medical staff, 54% of medical clowns) thought that this placement policy should change. In Study 3, data from health consumers in seven different hospital wards showed that clowns are useful in mitigating the effect of negative affectivity on satisfaction, thereby reducing aggressive tendencies among health consumers under the age of 21.6 years. Surprisingly, medical clowns had the opposite effect on most adults: for health consumers who were exposed to the medical clown and were above the age of 21.6 negative affectivity was related to decreased satisfaction, and an increase in aggressive tendencies was observed.

DISCUSSION

Medical clowns are most useful in elevating satisfaction and reducing aggressive tendencies of children. Older adults, on the other hand, exhibit lower satisfaction and higher aggressive tendencies following exposure to the performance of medical clowns.

CONCLUSION

Medical clowns should be placed primarily in children's wards.

The effect of waiting on aggressive tendencies toward emergency department staff: Providing information can help but may also backfire

Introduction

Waiting is inevitable for customers of service organizations, yet having to wait can trigger aggression by care receivers toward hospital staff. We explore the effect of waiting times on care receivers’ sense of procedural justice and aggressive tendencies, and show the attenuating effects of providing explanatory information.

Methods

Data were collected using survey responses in two studies, both conducted in the waiting area of a large hospital emergency department. Study 1 (n = 328) was a quasi-experiment involving an intervention in which care receivers were provided with information about wait times. Study 1 included three phases: (1) pre-test (week 1, n = 98), in which no information was provided; (2) information condition (weeks 2 & 3, n = 155), in which information was provided through large signs and pamphlets; and (3) post-test (week 4, n = 75), in which no information was provided. Study 2 (n = 99) was conducted a year later and involved the same information provision as the intervention stage of Study 1.

Results

The longer the wait duration, the lower care receivers’ procedural justice perceptions and the greater their aggressive tendencies. Information provision moderated the association, such that receiving information reduced aggressive tendencies during shorter waits but increased aggressive tendencies during longer waits. We show these effects in two separate data collections, conducted one year apart.

Conclusion

Competing theories predict that explanatory information should variously reduce and increase aggressive tendencies among people waiting in a queue. Our findings resolve this contradiction by identifying boundaries for the effectiveness of providing information in reducing aggression. We show that providing information is likely to reduce aggression until such point as the wait duration becomes longer than expected based on the information provided.

Violence and burnout in health care emergency workers in Santiago, Chile: A survey-based cross-sectional study

Shortage of quantitative studies regarding health risks for emergency services workers is a concern for Chilean's occupational health organizations.

OBJECTIVE

To explore the incidence of violence and burnout in emergency services of the Metropolitan Region of Chile, and associations with workers' characteristics and workplace conditions.

METHODS

A cross-sectional study was carried out from January to August 2016. A self-reported questionnaire explored about frequency and seriousness of violence episodes and about symptoms of burnout with the Maslach Burnout Inventory.

RESULTS

Of the 565 workers participating, 71% (95% CI 66.7-74.5) said violence episodes occurred at least once a week; 71.3% (95% CI 67.3-75.0) were victims of some aggression in the previous 12 months. Patients companions, relatives or friends arose as the main aggressors and the severity of the episodes was considered slight or moderate by more than 50% of participants. Fifty-seven respondents (10.5%, CI 95% 8.1-13.5) classified as having a burnout syndrome. Having been a victim of violence was associated to high emotional exhaustion (OR_adj = 1.7, 95% CI: 1.1-2.8) and depersonalization (OR_adj = 2.0, 95% CI 1.3-3.3).

CONCLUSIONS

Violence is a problem in the emergency departments of Chile's Metropolitan Region. Burnout is also present and independently associated to violence.

"Please do not act violently towards the staff": Expressions and causes of anger, violence, and aggression in Israeli cancer patients and their families from the perspective of oncologists

Expressions of anger within the healthcare context are a common occurrence, particularly in clinical situations where patients can experience emotional distress in the face of illness. The purpose of this study was to examine one aspect of this phenomenon by looking at expressions and causes of anger among Israeli cancer patients and their families from the perspective of oncologists who treat them. Twenty-two Israeli oncologists were interviewed from three oncology centers between March 2013 and June 2014. The grounded theory method was used to collect and analyze the data. Our study revealed that oncologists are exposed to and cope with expressions and acts of anger, aggression, and violence from some of their cancer patients and their families. The causes of this anger include physician blame, unrealistic treatment expectations, perceived errors in communication, and lack of follow up with bereaved families. Our study also revealed that the cultural context affected patient-physician interactions, including anger. This context included a culture that has open interpersonal boundaries and is family-oriented; a multicultural society that includes citizens with different cultural norms and expectations around cancer care; and a strained healthcare system that leaves oncologists limited in time and resources, including limited access to palliative care. Policy implications include reducing oncologist workload by hiring more mental health professionals, having translators available on site to help with language barriers, reducing administrative burdens, and incorporating palliative care widely to help with the psychosocial and physical care of patients and families.

How psychology might alleviate violence in queues: Perceived future wait and perceived load moderate violence against service providers

INTRODUCTION

Queues are inherent to service encounters, as it is not always possible to provide service to all clients at the exact moment they request service. Queues involve waiting for a service in a specific place that might also be crowded, they obstruct the client's' goal of receiving service, and at times lead clients to mistreat service providers and in extreme cases even attack them violently. We show, in a hospital setting, that perceived predicted future wait and load can buffer the causes of violence towards service staff.

METHODS

We combine objective data on crowdedness, reports of violence, and durations of time people waited, with psychological measures of perceived load and perceived future wait, collected from 226 people in the Emergency Department (ED) of a large hospital. Visitors to the ED were recruited as they waited for service. They indicated their perceived load in the ED and their perceived remaining wait for service. This data was then triangulated with objective operational data regarding the actual number of people waiting for service (i.e., crowdedness) and objective data regarding staff calls to security to stop violent accounts.

RESULTS

We find that with increased crowdedness, there are more calls to security reporting violence. However, this relationship is moderated by two factors: when people perceive the future wait to be short and when they perceive the load on the system to be high. Moreover, a three-way interaction shows that crowdedness is associated with more incidents of violence, however high perceived load and low perceived future wait are associated with fewer violent incidents.

CONCLUSIONS

This paper demonstrates the relationship between crowded queues and violence towards service staff, and suggests two psychological mechanisms for buffering such violence: reducing perceived future wait and elevating perceived load.

Addressing Risks of Violence against Healthcare Staff in Emergency Departments: The Effects of Job Satisfaction and Attachment Style

Violence in the workplace is one of the most serious issues affecting the healthcare sector. The incidence of violent behaviour towards healthcare workers is increasing worldwide. It is difficult to assess the extent of the problem, however, as violent incidents are underreported. In fact, many doctors and nurses see violence-perpetrated primarily by patients and visitors (friends and relatives of patients)-as a part of their job. Several studies indicate that violent behaviour against healthcare workers has serious consequences for the professionals involved, as well as for the wider healthcare system. The purpose of this study was to ascertain the prevalence of patient and visitor violence in a number of emergency departments in northeastern Italy and to explore the relationship between violence and certain psychosocial factors (adult attachment style, age, and job satisfaction). Data were collected using an online questionnaire. Our results demonstrate that patient and visitor violence in emergency departments is a serious risk for nurses and doctors and that it is affected by several factors relating to both patient pathologies and the way the workplace and work patterns are organised. Previous studies indicate that the most common form of violence experienced in these contexts is emotional violence and that nurses are more likely than doctors to suffer emotional and physical violence. Based on multiple regression analysis of the data, it appears that greater age and higher scores in secure attachment are associated with reduced experience of emotional violence from patients and visitors. Furthermore, our results show that the relationship between secure attachment and the amount of patient-and-visitor-perpetrated emotional violence experienced is mediated by levels of job satisfaction. We also discuss the potential implications of these results in terms of using staff training to prevent and manage patient and visitor violence and improve the safety of healthcare professionals.

Experiencing External Workplace Violence: Differences in Indicators Between Three Types of Emergency Responders

Police officers, firefighters, and emergency medical workers are at a relatively high risk of experiencing external workplace violence (EWPV), that is, violence initiated by people outside the organization. Based on criminal opportunities theories, the aim of this research was to study to what extent socio-demographic and work characteristics are related to experiencing EWPV. In addition, the aim was to explore how these relations differ between the three types of emergency responders. Data from a workplace violence survey of the Ministry of the Interior and Kingdom Relations of the Netherlands was used, from which emergency medical workers ( n = 264), firefighters ( n = 255), and police officers ( n = 296) were selected. Results indicated that police officers experienced most and firefighters experienced least EWPV. Younger professionals and professionals who have more frequent and risky contact experienced more EWPV. The expectations that males and those with less skills or experience to avoid EWPV experience more EWPV were not convincingly supported. The relationships between characteristics and EWPV, and the explanatory power of the models, differed between types of emergency responders. The studied characteristics best explained variations in EWPV of police officers, and therefore prevention of EWPV by addressing these characteristics will be most successful for police officers. The prediction of EWPV should be improved, for example, by studying the relationship with "attractiveness" or "vulnerability" of the possible victim, such as psychological characteristics of professionals. The study showed that research about indicators and prevention of EWPV should be aimed at separate professions.

Management of Violence and Aggression in Emergency Environment; a Narrative Review of 200 Related Articles

CONTEXT

The aim of this study is to reviewing various approaches for dealing with agitated patients in emergency department (ED) including of chemical and physical restraint methods.

EVIDENCE ACQUISITION

This review was conducted by searching "Violence," "Aggression," and "workplace violence" keywords in these databases: PubMed, Scopus, EmBase, ScienceDirect, Cochrane Database, and Google Scholar. In addition to using keywords for finding the papers, the related article capability was used to find more papers. From the found papers, published papers from 2005 to 2018 were chosen to enter the paper pool for further review.

RESULTS

Ultimately, 200 papers were used in this paper to conduct a comprehensive review regarding violence management in ED. The results were categorized as prevention, verbal methods, pharmacological interventions and physical restraint.

CONCLUSION

In this study various methods of chemical and physical restraint methods were reviewed so an emergency medicine physician be aware of various available choices in different clinical situations for agitated patients.

Utilizing compassion and collaboration to reduce violence in healthcare settings

Violence in healthcare settings is a global problem and violent acts are more likely to occur in emergency departments (EDs). Significant barriers to reporting workplace violence persist among healthcare workers. This, and lack of shared definitions and metrics, increase the difficulty of assessing its prevalence, understanding its causes, and comparing the impact of interventions to reduce its frequency. While risk factors for violence in EDs have been articulated, less is known about how the perspectives of patients and accompanying persons, and their interactions with ED staff may contribute to violence.

We discuss the nature and social context of ED violence and some approaches used to address this problem in the U.S. We argue that perpetrators of violence as well as healthcare staff who experience ED violence suffer when it occurs. While securing safety is paramount, compassionate practices to address this suffering and the social context from which it emerges should be developed and provided for all involved. Collaboration among stakeholders, including patients and family members, may lead to effective approaches to address this problem.

Factors related to negative feelings experienced by emergency department patients and accompanying persons: an Israeli study

Background

Studies on hospital violence have emphasized the importance of staff- service recipient interaction in leading to violent incidents. These incidents are the extreme result of service recipients’ frustration and anger in their interaction with staff.

The aim of this study was to analyze factors related to negative experiences of emergency department (ED) patients and accompanying persons in Israeli hospitals.

Methods

Structured interviews with 692 participants in seven major general Israeli hospitals: 322 patients and 370 accompanying persons.

Results

Negative feelings while in the ED were reported by 23.6% of patients and 20.5% of accompanying persons. Eight aggregate variables relating to staff-patients/accompanying persons interaction were identified: 1. General attitudes of staff and quality of ED experience; 2. Staff attitudes towards patients; 3. Staff attitudes towards accompanying persons; 4. Waiting; 5. Quality of perceived medical care; 6. Information provided to patients and accompanying persons; 7. Information provided to patients, as reported by accompanying persons; and 8. Severity of medical problem. Among patients, the only significant aggregate variable related to anger and frustration was perceived quality of care. Among accompanying persons, the three significant contributors to negative feelings were: 1. Staff’s general attitudes; 2. Attitudes towards patients; and 3. Severity of patients’ medical problem. Analysis of specific items within the variables revealed that, whereas patients’ negative feelings were related to nurses’ perceived negative attitudes those of accompanying persons were related to the doctors’ perceived negative attitudes. In addition, patients’ negative feelings were related to low severity of medical problem, whereas accompanying persons’ negative feelings were related to patients’ low severity of pain.

Conclusions

The study reveals the importance of including both patients and accompanying persons in the analysis of staff-service recipient interactions in EDs. The results are discussed in terms of patients’ and accompanying persons’ different perspectives. Three practical implications of the results are put forward, aiming at reducing patients/accompanying persons-staff frictions in the EDs, thus decreasing the potential of violent outbursts against ED staff: (1) implementing a framework based on “patient-centeredness” for the restoration of patient’s sense of agency and empowerment; (2) broadening the scope of laws concerning patient’s rights to include their families and other accompanying persons; and (3) implementing courses on interpersonal and human service skills, as well as teaching skills of handling emotional stressors experienced by both the staff and service recipients.

Violence against physicians and nurses in a hospital: How does it happen? A mixed-methods study

Background

Violence against medical personnel is unexpected in hospitals which are devoted to healing, and yet, it is frequent and of concern in the health system. Little is known about the factors that lead to hospital violence, and even less is known about the interactions among these factors.

The aim of the study was to identify and describe the perceptions of staff and patients regarding the factors that lead to violence on the part of patients and those accompanying them.

Methods

A mixed-methods study in a large, general, university tertiary hospital. A self-administered survey yielding 678 completed questionnaires, comprising 34% nurses and 66% physicians (93% response rate). Eighteen in-depth interviews were conducted separately with both victims and perpetrators of violent episodes, and four focus-groups (N = 20) were undertaken separately with physicians, staff nurses, head-nurses, and security personnel.

Results

Violence erupts as a result of interacting factors encompassing staff behavior, patient behavior, hospital setting, professional roles, and waiting times. Patients and staff reported similar perceptions and emotions regarding the episodes of violence in which they were involved. Of 4,047 statements elicited in the staff survey regarding the eruption of violence, 39% referred to staff behavior; 26 % to patient/visitor behavior; 17% to organizational conditions, and 10% to waiting times. In addition, 35% of the staff respondents reported that their own behavior contributed to the creation of the most severe violent episode in which they were involved, and 48% stated that staff behavior contributed to violent episodes. Half of the reasons stated by physicians and nurses for violence eruption were related to patient dissatisfaction with the quality of service, the degree of staff professionalism, or an unacceptable comment of a staff member. In addition, data from the focus groups pointed to lack of understanding of the hospital system on the part of patients, together with poor communication between patients and providers and expectations gaps.

Conclusions

Our various and triangulated data sources show that staff and patients share conditions of overload, pressure, fatigue, and frustration. Staff also expressed lack of coping tools to prevent violence. Self-conscious awareness regarding potential interacting factors can be used to develop interventions aimed at prevention of and better coping with hospital violence for both health systems' users and providers.

Workplace violence in a tertiary care Israeli hospital - a systematic analysis of the types of violence, the perpetrators and hospital departments

BACKGROUND

Worldwide, there is a widespread and disturbing pattern of violence towards healthcare workers. However, violent occurrences in Israeli hospitals have often been unrecognized and underreported. Moreover, most studies have not sufficiently differentiated among the different types of violence. To examine the different types of violence experienced by nurses and physicians, the types of perpetrators and the specialty fields involved.

METHODS

A quantitative questionnaire was used to assess the incidence of a "basket" of violent behaviors, divided into eight types of violent manifestations. The study population consisted of 729 physicians and nurses in a variety of hospital divisions and departments (surgery, oncology, intensive care, ambulatory services including day care, and emergency room) in a large general hospital. Six hundred seventy-eight of them responded to the survey for a response rate of 93%; about two thirds of respondents (446) were nurses and about one third (232) were physicians. The questionnaires were completed during staff meetings and through subsequent follow-up efforts.

RESULTS

In the 6 months preceding the survey, the respondents experienced about 700 incidents of passive aggressive behavior, 680 of verbal violence and 81 of sexual harassment. Types of violence differed between patients and companions; for example, the latter exhibited more verbal, threatening and passive aggressive behaviors. Violence was reported in all departments (ranging from 52-96%), with the departments most exposed to violence being the emergency room and outpatient clinics. Nurses in the emergency room were 5.5 times at a higher risk of being exposed to violence than nurses in the internal medicine department. Nurses were exposed to violence almost twice as much as physicians. There was a positive association between the physician's rank and his/her exposure to violence. A multiple regression model found that being older reduced the risk of being exposed to violence, for both physicians and nurses.

CONCLUSIONS

These findings suggest that uniform definitions of a range of different violent behaviors and assessments of their prevalence are important to creating an improved discourse about hospital violence in both research and operational settings. The study findings could assist policy makers in the Israeli healthcare system in implementing interventions on a national level and can promote leaders' commitment to violence prevention and management. This is an important contribution, as executive commitment is necessary and critical for the necessary organizational changes to occur.

Workplace violence against emergency versus non-emergency nurses in Mansoura university hospitals, Egypt

Workplace violence (WPV) against nurses is a common but neglected problem in Egypt. The objectives are to estimate the prevalence and associated risk factors of different types of violence against nurses working in the emergency hospital compared with those working in non-emergency clinics, circumstances of violence, type of perpetrators, and victims' response. This cross-sectional comparative study was carried out at Mansoura University Hospitals, Egypt, during January 2013. The data were collected through the adapted version of a self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization/Public Services International on WPV in the health sector. All types of WPV are common among nurses. Precipitating factors for violent incidents identified by respondents are emergency specialty, having work shift, and younger age. Violent incidents result in work dissatisfaction and consequently impair work productivity. Nurses working in emergency hospital experienced a higher level of different types of WPV. There is an urgent need to formulate and implement a policy for dealing with violent events.

Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: a review of the literature and existing occupational injury data

PROBLEM

Non-fatal type II violence experienced by hospital workers (patient/visitor-on-worker violence) is not well described.

METHODS

Hospital administration data (2004-2009) were examined for purposes of calculating rates of type II violent events experienced by workers. We also conducted a review of the hospital-based literature (2000-2010) and summarized findings associated with type II violence.

RESULTS

484 physical assaults were identified in the data, with a rate of 1.75 events/100 full-time equivalents. Only few details about events were captured, while non-physical events were not captured. The literature yielded 17 studies, with a range proportion of verbal abuse (22%-90%), physical threats (12%-64%) and assaults (2%-32%) reported. The literature lacked rigorous methods for examining incidence and circumstances surrounding events or rates of events over time.

DISCUSSION

For purposes of examining the impact of type II violence on worker safety, satisfaction and retention, rigorous surveillance efforts by hospital employers and researchers are warranted.

Prospective study of violence against ED workers

BACKGROUND

Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events.

OBJECTIVE

The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity.

METHODS

A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used.

RESULTS

Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) (P = .0017) and patient care assistants (P < .05). The RNs felt less safe than the MDs (P = .0041). The MDs felt more confident than the RNs in dealing with violent patients (P = .013). The RNs were more likely to experience acute stress than the MDs (P < .001). Acute stress reduced productivity (P < .001).

CONCLUSION

Emergency department HCWs are frequent victims of violence perpetrated by visitors and patients. This results in injuries, acute stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties.

Encountering anger in the emergency department: identification, evaluations and responses of staff members to anger displays

Background. Anger manifestations in emergency departments (EDs) occur daily, interrupting workflow and exposing staff to risk. Objectives. How staff assess and recognize patients' angry outbursts in EDs and elucidate responses to anger expressions, while considering effects of institution guidelines. Methods. Observations of staff patient interaction in EDs and personal interviews of staff (n = 38) were conducted. Two questionnaires were administered (n = 80 & n = 144). Assessment was based mainly on regression statistic tests. Results. Staff recognizes two types of anger displays. Magnitude of anger expressions were correlated with staff's fear level. Staff's responses ranged from ignoring incidents, giving in to patients' requests or immediately calling security. When staff felt fear and became angry they tended to call security. Staff was more likely to ignore anger when incident responsibility was assigned to patients. Discussion. Anger encounters are differentiated according to intensity level, which influences interpretations and response. Organizational policy has an effect on staff's response. Conclusions. Staff recognizes anger at varying levels and responds accordingly. The level of danger staff feels is a catalyst in giving in or calling security. Call security is influenced by fear, and anger. Permanent guidelines can help staff in responding to anger encounters.

Work-related violence against security guards--who is most at risk?

Studies on violence in the work of security guards are largely lacking. This study is unique in that it focuses on security guards (n=1,010) in Finland, and assesses the different forms, prevalence, and risk factors of the work-related violence they often face. Information to a survey instrument was obtained by first interviewing 30 volunteers. Then we made a cross-sectional mailed survey that was sent to a randomized group of 2,000 security guards. The response rate was 52. We found the prevalence of verbal aggression, threats of assault, and physical acts against security guards at least once a month to be 39%, 19%, and 15% respectively. As regards risk factors and who is most at risk, our results show that male gender, young age, low work experience, late working hours, and time pressure were associated with all three forms of work-related violence. Unlike other forms of violence, verbal aggression was highly prevalent outside the metropolitan area and directed towards both more and less experienced security guards. In prevention policies for violence, it is important to identify high-risk groups such as those who have less work experience.

Security rules and banned items in psychiatric acute admission wards in Athens, Greece

Mental health nurses play a key role in maintaining the safety of patients, themselves, and others during hospitalization. The aim of the research was to evaluate the safety measures that are taken by mental health nurses to identify the security policies that exist in acute mental health wards. The Ward Safety and Security Rules Survey was used as a method of data collection. Descriptive analysis and content analysis were carried out in order to identify nurses' practices. The total sample consisted of 172 mental health nurses and nurses' assistants who worked in 14 acute inpatient psychiatric wards in three psychiatric hospitals in the greater area of Athens, Greece. The results show a minimum number of security features existing in the wards. Only one of the 14 wards had an intercom system. In only nine wards, there was a panic alarm in the office, and in eight, an emergency response telephone extension. A wide range of practices were noted concerning banned items and patient searches upon admission and return from leave. The results indicate the significant lack of protocols and specific safety rules to guide nurses' actions across psychiatric acute admission wards in Athens.

Workplace violence against Iranian nurses working in emergency departments

BACKGROUND

Nurses working in emergency departments (EDs) are in the most danger of workplace violence (WPV) because of the critical nature of the wards.

AIMS

This study aimed to find the frequency and nature of physical and verbal WPV against Iranian nurses working in EDs.

METHODS

A cross-sectional study was carried out using consensus sampling of 196 bachelor's degree nurses working in 11 EDs of teaching hospitals in Tehran, Iran. The data were collected through the adapted version of a self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization/Public Services International on WPV in the health sector. The gathered data were analysed using descriptive and inferential statistics.

RESULTS

The participants were mostly (89.1%) female and their work experiences (63.2%) in nursing were between 1 and 5 years; 19.7% of the nurses had faced physical violence. All of the physical violence incidents were without-weapon; 91.6% of the participants experienced verbal abuse during the past year. Patients' relatives were the most common source of violence. Dissatisfaction was reported on the way the incidents were handled.

CONCLUSION

It is believed that finding the pattern and nature of WPV is the first step to develop suitable strategies to deal with the issue. Establishing WPV management teams and enacting appropriate laws can improve workplace safety for nurses and patients' care quality.