Personal safety in the accident and emergency department

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.

Factors influencing violence at emergency departments: Patients' relatives' perspectives

INTRODUCTION

In hospitals, the places where the highest rate of violence is perpetrated are emergency departments (EDs). Evaluating patient relatives' perceptions of violence and obtaining their views about how to prevent violence incidents are important in terms of uncovering the factors that increase violent behaviors. This study was aimed at determining the factors increasing violence in the emergency department (ED) from the perspectives of patient relatives.

METHODS

The sample of this study consisted of 520 individuals who brought a relative to the Adult ED of Akdeniz University Hospital in Turkey between April 2017 and June 2017. Data was collected using a two-part questionnaire prepared by the researcher. The first part consists of 15 items questioning the demographic characteristics of the participants. The second part consists of 20 statements asked the participants to rate the reasons urged patients or their relatives to perpetrate violence in the emergency department. Numbers and percentage calculations were used to evaluate the data.

RESULTS

Of the participants, 55.6% were men and 54.7% were married. According to the participants' statements, of the relatives of the 520 patients, 141 (27.1%) witnessed verbal violence against emergency department staff, 76 (14.6%) witnessed physical violence against emergency department staff, 9 (1.7%) witnessed verbal threat against emergency department staff, especially against nurses. According to the participants, the primary factor causing people to perpetrate violence at EDs was that patients or their relatives were not adequately informed about the patient's condition. More than 40% of patients' relatives said that anxiety and nervousness arising from being a patient's relative, and stress and sadness they suffered were among the leading factors causing people to perpetrate violent incidents.

CONCLUSION

In order to prevent and decrease incidents of violence in the emergency departments, healthcare systems should be reviewed and revised. Our study revealed that informing patients and their relatives about the patient's condition and empathic approaches displayed by healthcare employees towards patients reduced the number of incidents of violence. Unlike other studies, this study addresses the negative experiences of patients' relatives in the emergency department and the factors influencing these experiences. Obtaining the opinions of the patients' relatives about possible solutions to the violent events in the ED makes this study unique.

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.

Security Implications of Physical Design Attributes in the Emergency Department

BACKGROUND

Security, a subset of safety, is equally important in the efficient delivery of patient care. The emergency department (ED) is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel.

OBJECTIVE

The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of ED operations.

METHOD

An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states.

RESULTS

Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations.

CONCLUSION

Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article.

Patient safety in ambulance services: a scoping review

Background

The role of ambulance services has changed dramatically over the last few decades with the introduction of paramedics able to provide life-saving interventions, thanks to sophisticated equipment and treatments available. The number of 999 calls continues to increase, with adverse events theoretically possible with each one. Most patient safety research is based on hospital data, but little is known concerning patient safety when using ambulance services, when things can be very different. There is an urgent need to characterise the evidence base for patient safety in NHS ambulance services.

Objective

To identify and map available evidence relating to patient safety when using ambulance services.

Design

Mixed-methods design including systematic review and review of ambulance service documentation, with areas for future research prioritised using a Delphi process.

Setting and participants

Ambulance services, their staff and service users in UK.

Data sources

A wide range of data sources were explored. Multiple databases, reference lists from key papers and citations, Google and the NHS Confederation website were searched, and experts contacted to ensure that new data were included in the review. The databases MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, Emerald, Education Resources Information Center (ERIC), Applied Social Sciences Index and Abstracts, Social Services Abstracts, Sociological Abstracts, International Bibliography of the Social Sciences (IBSS), PsycINFO, PsycARTICLES, Health Management Information Consortium (HMIC), NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED),Health Technology Assessment, the FADE library, Current Awareness Service for Health (CASH), OpenDOAR (Directory of Open Access Repositories) and Open System for Information on Grey Literature in Europe (OpenSIGLE) and Zetoc (The British Library's Electronic Table of Contents) were searched from 1 January 1980 to 12 October 2011. Publicly available documents and issues identified by National Patient Safety Agency (NPSA), NHS Litigation Authority (NHSLA) and coroners’ reports were considered. Opinions and perceptions of senior managers, ambulance staff and service users were solicited.

Review methods

Data were extracted from annual reports using two-stage thematic analysis, data from quality accounts were collated with safety priorities tabulated and considered using thematic analysis, NPSA incident report data were collated and displayed comparatively using descriptive statistics, claims reported to NHSLA were analysed to identify number and cost of claims from mistakes and/or poor service, and summaries of coroners’ reports were assessed using thematic analysis to identify underlying safety issues. The depth of analysis is limited by the remit of a scoping exercise and availability of data.

Results

We identified studies exploring different aspects of safety, which were of variable quality and with little evidence to support activities currently undertaken by ambulance services. Adequately powered studies are required to address issues of patient safety in this service, and it appeared that national priorities were what determined safety activities, rather than patient need. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology.

Conclusion

Patient safety needs to become a more prominent consideration for ambulance services, rather than operational pressures, including targets and driving the service. Development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care, particularly to a mobile workforce often isolated from colleagues, which requires a body of supportive evidence and an inherent critical evaluation culture. It is difficult to extrapolate findings of clinical studies undertaken in secondary care to ambulance service practice and current national guidelines often rely on consensus opinion regarding applicability to the pre-hospital environment. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Verbalno in posredno nasilje v urgentni dejavnosti

Uvod: Namen raziskave je bil proučiti pojavnost verbalnega in drugih oblik posrednega nasilja na vzorcu zaposlenih v zdravstveni negi v urgentni dejavnosti, in sicer identificirati pogostost doživljanja, oblike nasilja, najpogostejše povzročitelje nasilja, zaznane vzroke ter demografske spremenljivke zaposlenih, ki nasilje na delovnem mestu zaznavajo pogosteje. Metode: Raziskava je bila opravljena na nenaključnem vzorcu zaposlenih v zdravstveni negi v urgentnih ambulantah primarne in sekundarne ravni zdravstvenega varstva (n = 62) v severnoprimorski regiji. Uporabljen je bil strukturirani vprašalnik, ki je vključeval 18 vprašanj. Podatki so bili obdelani s frekvencami, strukturnimi deleži in testom χ2. Rezultati: Dve tretjini udeležencev (46 izborov oz. 74,2 %) je že doživelo verbalno ali druge oblike posrednega nasilja na delovnem mestu, predvsem v obliki aktivnega neposrednega verbalnega nasilja s strani svojcev in pacientov. Najpogosteje zaznani razlogi nasilja so neustrezni, prenapolnjeni čakalni prostori (36 izborov). Tovrstno nasilje pogosteje zaznavajo zaposleni z daljšo delovno dobo (χ2 = 9,841, p = 0,003) ter starejši delavci (χ2 = 4,891, p = 0,041). Stopnja verbalnega in posrednega nasilja se je po oceni udeležencev z leti zmerno do opazno povečala. Diskusija in zaključek: Dobljeni rezultati so primerljivi z rezultati raziskav v tujini. Nadaljnje raziskave se morajo usmeriti v podrobnejšo fenomenološko izkušnjo doživljanja nasilja na delovnem mestu.

Aggression and violence towards health care providers--a problem in Turkey?

Health care providers are increasingly concerned about the escalating incidence of verbal and physical abuse to healthcare staff. Factors, such as long wait in hospital areas, which lead to client frustration over an inability to obtain needed services promptly, are influencing these situations. Nonetheless, incidents of this nature can cause immense psychological harm as well as physical damage among medical employees. The current study aimed to ascertain from staff members aggressive experiences in the workplace, and the effects on the individual. The results of this study mirrored those of similar surveys in Turkey. Non-reporting was revealed as a major problem. Respondents believed they were treated less seriously than similar incidents involving private citizens. Accordingly, staff criticized hospital managers, the police, and the courts for their attitude about assaults towards hospital employees. They reported feeling vulnerable to abuse and there was a general desire for training in preventing and protection. These include teaching staff breakaway techniques, increasing the number of trained security officers on duty, issuing personal alarms, and encouraging staff to officially report all incidents.

Abuse - a day in the life of a student nurse

Unbelievably (to me at least), according to new research presented at the Royal College of Nursing’s 2007 International research Conference on 1st of May, nearly half of student nurses surveyed by a London University have been verbally abused while on their work experience placements.