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Yap CYL, Daniel C, Knott JC, Myers E, Gerdtz M. Causes and management of aggression and violence: A survey of emergency department nurses and attendees. Int Emerg Nurs 2023; 69:101292. [PMID: 37150146 DOI: 10.1016/j.ienj.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/12/2023] [Accepted: 03/26/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Celene Y L Yap
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia; Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia.
| | - Catherine Daniel
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia; Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia.
| | - Jonathan C Knott
- Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia; Department of Medical Education, The University of Melbourne, Victoria 3010, Australia.
| | - Erin Myers
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia.
| | - Marie Gerdtz
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia; Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia.
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Brune S, Killam L, Camargo-Plazas P. Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper. Issues Ment Health Nurs 2023; 44:437-452. [PMID: 37167098 DOI: 10.1080/01612840.2023.2205502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
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Affiliation(s)
- Sara Brune
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Nursing (BSN) Program, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Laura Killam
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health Sciences and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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Soenen C, Van Overmeire R, Six S, Bilsen J, De Backer L, Glazemakers I. Aggression in mental health care: Opportunities for the future-A qualitative study on the challenges when defining and managing aggression across inpatient disciplines. J Psychiatr Ment Health Nurs 2023. [PMID: 36708052 DOI: 10.1111/jpm.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Aggression towards caregivers is a global phenomenon in mental health care. Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub-par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression. Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de-escalating aggression as well as diminishing the use of coercive measures. Further primary research exploring the opportunities of non-coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers is also needed. ABSTRACT INTRODUCTION: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non-coercive measures. AIM The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. METHOD A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. RESULTS Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. DISCUSSION In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression-tolerating" workplace. IMPLICATIONS FOR PRACTICE Three implications for practice were identified: (1) It is vital for residential units to agree on a broad-based definition of aggression, (2) further primary research exploring the opportunities of non-coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers also needs further study.
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Affiliation(s)
- Clemens Soenen
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and Odisee University of Applied Sciences, Antwerp, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stefaan Six
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lieve De Backer
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
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Dunsford J. Nursing violent patients: Vulnerability and the limits of the duty to provide care. Nurs Inq 2021; 29:e12453. [PMID: 34398479 PMCID: PMC9286030 DOI: 10.1111/nin.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, “reasonableness” remains undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care.
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Affiliation(s)
- Jennifer Dunsford
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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Dafny HA, Beccaria G. I do not even tell my partner: Nurses’ perceptions of verbal and physical violence against nurses working in a regional hospital. J Clin Nurs 2020; 29:3336-3348. [DOI: 10.1111/jocn.15362] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/09/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Hila A. Dafny
- School of Nursing and Midwifery Faculty of Health Engineering and Sciences University of Southern Queensland Toowoomba Australia
| | - Gavin Beccaria
- School of Psychology and Counselling Faculty of Health Engineering and Sciences University of Southern Queensland Toowoomba Australia
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Workplace violence: Examination of the tensions between duty of care, worker safety, and zero tolerance. Health Care Manage Rev 2020; 45:E13-E22. [PMID: 32358237 DOI: 10.1097/hmr.0000000000000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Workplace violence (WPV) remains an international problem. This raises challenges for staff in meeting their duty of care to consumers while enforcing zero tolerance for violence directed toward them. PURPOSE The aim of the study was to expose the values and beliefs underpinning practice and reveal any flawed assumptions or evidence, upon which decisions related to WPV are made. By increasing staff awareness, the secondary aim is to decrease staff stress when confronted with conflicting policies and duty of care responsibilities. METHODOLOGY Explanatory research as part of a larger descriptive study was used. Semistructured interviews with a sample of managers and staff (n = 99) in Victorian Health Services (Australia) were performed. Initial descriptive analysis identified a tension between duty of care, worker safety, and zero tolerance. This article reports the secondary analysis to examine these relationships in depth. FINDINGS Feeling obligated and providing care for aggressive patients was difficult while maintaining own safety: "You cannot do both." Although there were contrasting views about the merits of zero tolerance, policies were rarely enacted: "We cannot refuse to treat." Incongruency between legislative requirements creates confusion for decision-making: "Which Act trumps what?" CONCLUSION Despite policies supporting zero tolerance, staff do not enact these because they prioritize duty of care to consumers before duty of care to self. Zero tolerance, with incongruent legislation, compounds this tension and impairs decision-making. PRACTICAL IMPLICATIONS This article exposes the underlying values, beliefs, and flawed assumptions underpinning practice related to WPV. Managers need to amend policies to reduce staff confusion, adopt a trauma-sensitive and resilience approach, and develop a clearly written framework to guide decision-making related to duty of care to consumers and staff safety. Incident reports and staff well-being/satisfaction surveys need to evaluate the effects of zero tolerance on staff and consumers. Regulators need to ensue legislative requirements are congruent with staff safety and well-being.
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Ming JL, Huang HM, Hung SP, Chang CI, Hsu YS, Tzeng YM, Huang HY, Hsu TF. Using Simulation Training to Promote Nurses' Effective Handling of Workplace Violence: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193648. [PMID: 31569382 PMCID: PMC6801794 DOI: 10.3390/ijerph16193648] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/03/2023]
Abstract
Background: Workplace violence in the health care sector has become a growing global problem. Research has shown that although caregivers comprise a high-risk group exposed to workplace violence, most of them lacked the skills and countermeasures against workplace violence. Therefore, through a quasi-experimental design, this study aimed to investigate the effectiveness of situational simulation training on the nursing staffs’ concept and self-confidence in coping with workplace violence. Methods: Workplace violence simulation trainings were applied based on the systematic literature review and the conclusions from focus group interviews with nursing staff. Data were obtained from structured questionnaires including: (1) baseline characteristics; (2) perception of aggression scale (POAS); and (3) confidence in coping with patient aggression. Results: The results revealed that training course intervention significantly improved the nursing staffs’ self-perception and confidence against workplace violence (p < 0.001). Conclusions: The “simulation education on workplace violence training” as the intervention significantly improved the workplace violence perception and confidence among nursing staffs in coping with aggression events.
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Affiliation(s)
- Jin-Lain Ming
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Hui-Mei Huang
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Shiao-Pei Hung
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Ching-I Chang
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Yueh-Shuang Hsu
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Yuann-Meei Tzeng
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Hsin-Yi Huang
- Department of Biostatistics Task Force, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Teh-Fu Hsu
- Emergency Department, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
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Dadashzadeh A, Rahmani A, Hassankhani H, Boyle M, Mohammadi E, Campbell S. Iranian pre-hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study. J Nurs Manag 2019; 27:1190-1199. [PMID: 31104356 DOI: 10.1111/jonm.12791] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/27/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022]
Abstract
AIM To explore the experiences of Iranian nurses working in pre-hospital emergency care services and the strategies used to manage of workplace violence. BACKGROUND Pre-hospital emergency nurses are subject to workplace violence; however, little research addresses their experiences, particularly related to their strategies in dealing with workplace violence. METHODS A descriptive qualitative study that involved nineteen male nurses who were working in pre-hospital services collected data using semi-structured interviews and analysed it using qualitative content analysis. RESULTS Data analysis yielded four descriptive categories including no reaction to violence (tolerance and acceptance as common workplace conflicts), situational management (patient and scene management), confrontation (direct and indirect) and escaping the scene. Patient management was the dominant strategy used and had the best outcomes related to both patient and personnel safety. CONCLUSION This study showed that pre-hospital nurses use different strategies to manage violence and patient management was a common and useful strategy for managing workplace violence. However, the pre-hospital nurses have little training, insufficient support and are poorly prepared to manage workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT The development of context-based guidelines, continuing education, better-equipped ambulances that include medical and defence equipment, as well as better coordination of the police force in ambulance operations, can help to reduce workplace violence.
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Affiliation(s)
- Abbas Dadashzadeh
- Medical-Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Medical-Surgical Department, Nursing and Midwifery Faculty, Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hassankhani
- Medical-Surgical Department, Nursing and Midwifery Faculty, Center of Qualitative Studies, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Malcolm Boyle
- Academic Lead in Paramedic Education, School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Eisa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Suzanne Campbell
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Hills D, Lam L, Hills S. Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel. Collegian 2018. [DOI: 10.1016/j.colegn.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ashton RA, Morris L, Smith I. A qualitative meta-synthesis of emergency department staff experiences of violence and aggression. Int Emerg Nurs 2018; 39:13-19. [PMID: 29326038 DOI: 10.1016/j.ienj.2017.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/22/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue. METHOD A meta-ethnographic approach was used to review papers. RESULTS Four concepts were identified: 'The inevitability of violence and aggression'; 'Staff judgments about why they face violence and aggression'; 'Managing in isolation'; and 'Wounded heroes'. DISCUSSION Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation. Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor. Staff often felt isolated when managing violence and aggression. Key recommendations included: Staff training in understanding violence and aggression and clinical supervision. CONCLUSION 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.
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Affiliation(s)
| | - Lucy Morris
- Merseycare NHS Foundation Trust, Whalley, Lancashire BB7 9PE, UK
| | - Ian Smith
- Furness College, Lancaster University, Lancaster LA1 4YG, UK.
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Hallett N, Dickens GL. De-escalation of aggressive behaviour in healthcare settings: Concept analysis. Int J Nurs Stud 2017; 75:10-20. [DOI: 10.1016/j.ijnurstu.2017.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/05/2017] [Accepted: 07/02/2017] [Indexed: 11/15/2022]
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Sun Y, Stone TE, Petrini MA. Swearing and verbal aggression in China: A call to action. Nurs Health Sci 2017; 19:139-141. [DOI: 10.1111/nhs.12317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/21/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Yan Sun
- HOPE School of Nursing; Wuhan University; Wuhan China
| | | | - Marcia A. Petrini
- Dean Emeritus/Professor Wuhan University Wuhan China and Visiting Professor Chiang Mai University Chiang Mai; Thailand
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Lakeman R. Paradoxes of Personal Responsibility in Mental Health Care. Issues Ment Health Nurs 2016; 37:929-933. [PMID: 27858512 DOI: 10.1080/01612840.2016.1235637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personal responsibility is widely considered important in mental health recovery as well as in popular models of alcohol and drug treatment. Neo-liberal socio-political rhetoric around consumerism in health care often assumes that people are informed and responsible for their own choices and behaviour. In the mental health care context and especially in emergency or crisis settings, personal responsibility often raises particular paradoxes. People often present whose behaviour does not conform to the ideals of the responsible consumer; they may seek and/or be granted absolution from irresponsible behaviour. This paradox is explored and clinicians are urged to consider the context-bound nature of personal responsibility and how attributions of personal responsibility may conflict with policy and their own professional responsibilities to intervene to protect others.
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Affiliation(s)
- Richard Lakeman
- a Faculty of Health , University of Tasmania , Hobart , Australia
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Braga IP, Souza JCD, Leite MB, Fonseca V, Silva EMD, Volpe FM. Contenção física no hospital psiquiátrico: estudo transversal das práticas e fatores de risco. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivos Descrever a utilização da contenção física em um hospital psiquiátrico público e analisar os fatores de risco associados com seu uso, no contexto da implantação de um protocolo clínico. Métodos Em um hospital psiquiátrico público de Belo Horizonte-MG, os formulários de registro e monitoramento de contenção física (2011-2012) foram analisados e comparados com os registros das demais internações englobadas no mesmo período. Neste estudo transversal, além das análises descritivas das características clínicas e demográficas dos pacientes contidos, das técnicas utilizadas e das complicações reportadas, os fatores de risco associados com o uso da contenção foram analisados por meio de regressão logística múltipla. Resultados A contenção foi utilizada em 13,4% das internações, sendo mais comum em pacientes jovens, do sexo masculino, portadores de psicoses não orgânicas, apresentando agitação/agressividade. A técnica foi geralmente de quatro pontos, durando entre 61-240 minutos. Os únicos fatores de risco significativos para o uso da contenção incluíram a idade (OR = 0,98; p = 0,008) e o tempo de permanência (OR = 1,01; p < 0,001). Conclusões A contenção física foi utilizada usualmente na abordagem aguda do paciente agitado/agressivo inabordável verbalmente, no contexto de um transtorno psicótico. O registro dos dados vitais e dos efeitos adversos foram os itens menos aderentes aos protocolos vigentes.
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Affiliation(s)
- Isabela Pinto Braga
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | - Jaqueline Conceição de Souza
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | - Milena Bellei Leite
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | | | | | - Fernando Madalena Volpe
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação Hospitalar do Estado de Minas Gerais, Brasil
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Angland S, Dowling M, Casey D. Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: A qualitative study. Int Emerg Nurs 2014; 22:134-9. [DOI: 10.1016/j.ienj.2013.09.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/16/2013] [Accepted: 09/20/2013] [Indexed: 11/26/2022]
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Morphet J, Griffiths D, Plummer V, Innes K, Fairhall R, Beattie J. At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses. AUST HEALTH REV 2014; 38:194-201. [DOI: 10.1071/ah13189] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/12/2014] [Indexed: 11/23/2022]
Abstract
Objective Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. Methods The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. Results Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED Conclusion There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence.
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McCullough KM, Lenthall S, Williams AM, Andrew L. Reducing the risk of violence towards remote area nurses: A violence management toolbox. Aust J Rural Health 2012. [DOI: 10.1111/j.1440-1584.2012.01313.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kylie M. McCullough
- Clinical Nursing and Midwifery Research Centre; Edith Cowan University; Joondalup, Perth; Western Australia; Australia
| | - Sue Lenthall
- Centre for Rural and Remote Health; Alice Springs; Northern Territory; Australia
| | - Anne M. Williams
- Clinical Nursing and Midwifery Research Centre; Edith Cowan University; Joondalup, Perth; Western Australia; Australia
| | - Lesley Andrew
- School of Nursing and Midwifery; Edith Cowan University; Joondalup, Perth; Western Australia; Australia
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Woodrow C, Guest DE. Public violence, staff harassment and the wellbeing of nursing staff: an analysis of national survey data. Health Serv Manage Res 2012; 25:24-30. [DOI: 10.1258/hsmr.2011.011019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Instances of physical violence from members of the public and non-physical harassment from colleagues are highly prevalent in the health-care workforce and can be damaging to both staff and patients. While policy has tended to focus on the more visible problem of public violence, little is known about which of the two behaviours is the most damaging. This study compared the consequences of public violence and staff harassment for wellbeing in two large samples of English nurses. The results revealed that while both types of aggression were related to decreased levels of staff wellbeing, staff harassment had a stronger negative association with wellbeing than public violence. The relationships between each of the types of aggression and some aspects of wellbeing were moderated by perceived supervisory support, such that the negative effects on wellbeing were greater for those with higher levels of support. The major implication of this study is that health-care organizations must pay more attention to the prevention of staff harassment in the workplace.
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Affiliation(s)
- Chris Woodrow
- NIHR King's Patient Safety & Service Quality Research Centre, Department of Management, King's College London, London, UK
| | - David E Guest
- NIHR King's Patient Safety & Service Quality Research Centre, Department of Management, King's College London, London, UK
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Pich J, Hazelton M, Sundin D, Kable A. Patient-related violence against emergency department nurses. Nurs Health Sci 2011; 12:268-74. [PMID: 20602701 DOI: 10.1111/j.1442-2018.2010.00525.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In a finding that reflects international experiences, nurses in Australia have been identified as the occupation at most risk of patient-related violence in the health-care sector. A search of the literature was undertaken to explore this concept, with a focus on the emergency department and triage nurses. Significant findings included the fact that nurses are subjected to verbal and physical abuse so frequently that, in many instances, it has become an accepted part of the job. This attitude, combined with the chronic under-reporting of violent incidents, perpetuates the normalization of violence, which then becomes embedded in the workplace culture and inhibits the development of preventative strategies and the provision of a safe working environment. Nurses are entitled to a safe workplace that is free from violence under both the occupational health and safety legislation and the zero-tolerance policies that have been adopted in many countries including Australia, the UK, Europe, and the USA. Therefore, policy-makers and administrators should recognize this issue as a priority for preventative action.
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Affiliation(s)
- Jacqueline Pich
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia.
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Anderson L, FitzGerald M, Luck L. An integrative literature review of interventions to reduce violence against emergency department nurses. J Clin Nurs 2010; 19:2520-30. [DOI: 10.1111/j.1365-2702.2009.03144.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Araújo EMD, Martins ES, Adams CE, Coutinho ESF, Huf G. Inquérito sobre o uso de contenção física em um hospital psiquiátrico de grande porte no Rio de Janeiro. JORNAL BRASILEIRO DE PSIQUIATRIA 2010. [DOI: 10.1590/s0047-20852010000200003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Investigar o uso da contenção física em hospital psiquiátrico no Rio de Janeiro. MÉTODOS: Um inquérito foi conduzido em agosto de 2009. As informações - sexo, idade, diagnóstico, ocorrência e duração de contenção física - foram coletadas no prontuário. RESULTADO: A amostra consistiu em 66 pacientes, dos quais 59% eram mulheres, com idade média de 44 anos. Durante o período estudado, 24% dos pacientes foram contidos no leito pelo menos uma vez, mas não é prática corrente o registro detalhado do procedimento. Não ocorreram eventos adversos importantes. Não houve associação entre o uso de contenção e variáveis sociodemográficas e clínicas. CONCLUSÕES: A prática de contenção física parece consistente nas emergências psiquiátricas do Rio de Janeiro: esse mesmo percentual foi observado em estudos conduzidos em três hospitais em outros momentos, 2001 e 2004, e situa-se em uma faixa intermediária em relação aos resultados observados em outros países. Não existem estudos randomizados para se fazer uma avaliação objetiva dos benefícios e riscos dessa prática, mas a segurança e a eficácia dessa intervenção deveriam ser objeto do mesmo escrutínio científico normalmente destinado aos outros tratamentos.
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Kontio R, Välimäki M, Putkonen H, Cocoman A, Turpeinen S, Kuosmanen L, Joffe G. Nurses' and physicians' educational needs in seclusion and restraint practices. Perspect Psychiatr Care 2009; 45:198-207. [PMID: 19566692 DOI: 10.1111/j.1744-6163.2009.00222.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to explore nurses' (N= 22) and physicians' (N= 5) educational needs in the context of their perceived seclusion and restraint-related mode of action and need for support. METHOD The data were collected by focus group (N= 4) interviews and analyzed with inductive content analysis. RESULTS Participants recognized a need for on-ward and problem-based education and infrastructural and managerial support. The declared high ethical principles were not in accordance with the participants' reliance on manpower and the high seclusion and restraint rates. PRACTICE IMPLICATIONS Future educational programs should bring together written clinical guidelines, education on ethical and legal issues, and the staff's support aspect.
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Affiliation(s)
- Raija Kontio
- University of Turku, Department of Nursing Science, Turku, Finland.
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Semonin-Holleran R. Summer in the City. J Emerg Nurs 2008; 34:284. [DOI: 10.1016/j.jen.2008.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The purpose of the present paper was to review the current models of mental health service delivery used in the emergency department (ED) setting. A search was conducted of the nursing and medical literature from 1990 to 2007 for relevant articles and reports. Consideration was also given to the global and local context influencing contemporary mental health services. Wider sociopolitical and socioeconomic influences and systemic changes in health-care delivery have dictated a considerable shift in attention for mental health services worldwide. The ED is a topical location that has attracted interest and necessitated a response. The mental health liaison nurse (MHLN) role embedded within the ED structure has demonstrated the most positive outcomes to date. This model aims to raise mental health awareness and address concerns over patient-focused outcomes such as reduced waiting times, therapeutic intervention and more efficient coordination of care and follow up for individuals presenting to the ED in psychological distress. Further research is required into all methods of mental health service delivery to the ED. The MHLN role is a cost-effective approach that has gained widespread approval from ED staff and mental health patients and is consistent with national and international expectations for mental health services to become fully integrated within general health care. The mental health nurse practitioner role situated within the ED represents a potentially promising alternative for enhanced public access to specialized mental health care.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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