Violence in the accident and emergency department

Terminology, stereotypes and aggressive dynamics in the accident and emergency department

There is a perception that violence against staff practising in accident and emergency (A&E) departments is increasing [Fernandes, C.M.B., Bouthillette, F., Raboud, J.M., Bullock, L., Moore, C.F., Christenson, J.M., Grafstein, E., Rae, S., Ouellet, L., Gillrie, C., Way, M., 1999. Violence in the emergency department: a survey of health care workers, Canadian Medical Association Journal 11, 1-6; Jenkins, M.G., Rocke, L.G., McNicholl, B.P., Hughes, D.M., 1998. Violence and verbal abuse against staff in the A and E departments: a survey of consultants in the United Kingdom and Republic of Ireland, Journal of Accident and Emergency Medicine 15, 262-265; . A survey of violence towards nursing staff in one large Irish Accident and Emergency department, Journal of Emergency Nursing 23(3), 214-219]. This paper discusses traditional stereotypes of the violent A&E client by critiquing the current literature. The paper then goes on to question whether some health care professionals themselves are contributing to a climate of fear and the development of conflict.

Violence in the accident and emergency department – An international perspective

Violence and aggression experienced by emergency nurses has been the focus of international concern. This paper examines the phenomena of violence experienced by emergency department nursing staff from an international perspective by reviewing original, published research studies. Methodological inconsistencies and concerns, a lack of comprehensive studies and persistent under-reporting may mean that the reality of clinical practise has not being captured by researchers. The literature suggests that clients presenting with weapons in the emergency department may be characteristic of North American departments but is much less likely to occur in the United Kingdom were weapons use is much more likely to be opportunistic. Excessive verbal abuse is a global phenomenon and nursing staff and organisations may be significantly affected by workplace violence. However, violence against nursing staff remains poorly researched or understood.

Violence towards nursing staff in emergency departments in one Turkish city

AIM

To determine the incidence of violence faced by nurses in emergency departments (ED) in a Turkish city, whether any of the incidents were reported and what legal action was taken. The second aim was to identify nurses' attitudes towards these incidents and the relevance of their professional background.

METHODS

Data were collected by questionnaire from the nurses working in the ED of four major hospitals in Izmir, Turkey. The questionnaire consisted of 34 questions seeking socio-demographic data, information on verbal and physical victimization and legal processes.

RESULTS

Sixty-six nurses (72%) agreed to participate in the study. One third (34.8%) of participants were relatively new in the profession (0-5 years), and the majority of nurses (71.2%) had an ED experience of less than 5 years. The incidence of verbal violence (98.5%) was significantly more frequent than physical violence (19.7%). However, most incidents remained unreported (83.5%); most of the reported cases did not result in legal action (63.7%). Almost half of the nurses believed that possible explanations for the violent incidents they faced were because they were less competent and inexperienced in the profession than more senior colleagues.

DISCUSSION

Victimized respondents mostly preferred to remain silent and did not report the incidents to the hospital administration since they believed that this would not result in legal action. It seems evident that our country lacks legal processes concerning job (workplace) violence. Effective legislative arrangements are necessary. Nurses and other ED staff also need continuing education concerning their rights and personal safety.

The lived experience of violence in accident and emergency

AIM

To investigate the lived experience of violence of nurses in one A&E department.

RATIONALE

Following an extensive literature review, it was elicited that there was very little evidence of the psychological impact of violence in A&E.

BACKGROUND/INTRODUCTION

Violence in the health service has increased over the last decade associated with a corresponding increase in the published literature on this topic. While violence in A&E departments would appear common, little evidence exists on the psychosocial impact of these incidents on A&E nurses.

RESEARCH METHODS

A qualitative domain using a phenomenological philosophy was utilised. Sampling was of a volunteer nature and data were collected using interview. Nurses were sampled from one major acute hospital in Northern Ireland.

RESULTS

Participants expressed feelings of frustration, anger, and fear. Support from colleagues was greatly valued and lack of feedback from management was cited as being common.

DISCUSSION

Frustration and anger were synthesised into the "why me" principle with nurses not knowing why they were the focus for attack. Violent incidents were associated with a sense of isolation but colleague support developed a sense of belonging.

CONCLUSIONS

Whilst a useful insight was provided, more research is essential into this emotive topic.

How prevalent is violence towards nurses working in general hospitals in the UK?

BACKGROUND

Violence in nursing is not a new phenomenon but in recent years much greater emphasis has been placed on the problem in the United Kingdom (UK). A number of official reports, media stories and national initiatives have focused attention on the problem in this country. However, it is not clear whether violence and abuse have in fact become more prevalent. At present little is known about the scale of the problem for general nurses working in general hospitals in the UK.

AIM OF THE STUDY

A realistic assessment of the scale of this problem should facilitate a meaningful debate about the interventions needed to counter it and support the requests for funding that will be required. This study aimed to establish the utility of existing research findings, to include relevant but previously unused sources and to synthesize the results.

METHOD

A systematic search of the literature pertinent to the aim of the study was followed by a critical review. The focus was on research originating in the UK, including some general research on occupational violence which included data on nurses.

FINDINGS

Overall, the research findings are limited. The best available evidence suggests nurses as a whole do face a high level of risk compared with all workers and this excess risk holds for general nurses. The data support a figure of more than 9.5% of general nurses working in general hospitals assaulted (with or without injury) in any 1 year. Trends over time are impossible to identify at present.

CONCLUSIONS

Efforts to combat the problem should include greater emphasis on the problem outside accident and emergency departments, prioritizing preregistration training in the management of aggression, and further research. Better reporting should also be a priority.

Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland

OBJECTIVES

To determine the incidence of verbal abuse and physical violence in accident and emergency (A&E) departments and to discover the extent of provision of security measures and instructions for staff on how to deal with these problems.

DESIGN

A postal questionnaire.

SETTING

A&E departments in the UK and the Republic of Ireland.

SUBJECTS

Two hundred and seventy three consultants named in charge of 310 departments.

MAIN OUTCOME MEASURES

Frequency of physical violence and verbal abuse, injuries sustained, perceived precipitating factors, security measures instituted, and legal action taken.

RESULTS

Two hundred and thirty three replies were received. Alcohol, waiting times, recreational drug usage, and patients' expectations were perceived as the chief causes. Patients were the chief perpetrators with nurses being the commonest victims. Staff sustained 10 fractures, 42 lacerations, and 505 soft tissue injuries. There were 298 arrests and 101 court appearances that resulted in 76 convictions. Panic buttons and video cameras were the most common security measures.

CONCLUSIONS

Staff within A&E departments are regularly abused, both verbally and physically. Inner city departments appear to be most affected. Documentation is poor. Perpetrators are seldom convicted. There do appear to be actions which hospitals could undertake that might help to ameliorate these problems.

Violence in the accident and emergency department

A survey of Accident and Emergency nurses was undertaken to study the prevalence, types and possible precipitating factors of violence in the workplace. Violence was sub-divided into physical and verbal. Verbal violence was more common than physical assault but often not reported. Often physical violence is under-reported but in fact had affected one third of respondents. Associations with different types of violence are discussed. The need for further training in defusing violent situations and analysis of violent incidents is identified. Some suggestions for inclusion in a training programme are given.

Violence towards junior doctors in accident and emergency departments

The experience and training of accident and emergency (A&E) junior doctors with regard to patient aggression was investigated by use of a telephone questionnaire. A total of 114 A&E departments in five different regions in the United Kingdom were telephoned. A total of 100 junior doctors answered the questionnaire. Verbal aggression had been experienced by 96 of them, 50 had received threats and 32 said that patients had tried to assault them. Eighteen doctors had been assaulted by patients on a total of 23 occasions. Thirty-two doctors admitted that they had been upset after a violent incident, so much so that they were preoccupied with it after work. None of those assaulted received any counselling and no police charges resulted from the assaults. Only 11 doctors had received any training on how to manage aggressive patients, although 88 believed that it would be useful. The results of this study indicate that violence towards junior doctors in A&E is a significant problem. Aspects of this problem, including training and support for staff, need to be addressed urgently.