Emergency nurses' experience with violence: does it affect nursing care of battered women?

OBJECTIVE: To determine what effect nurses' experience of interpersonal violence had on proposed nursing care of battered women ED patients. METHODS: One hundred ninety-five emergency nurses completed surveys on their personal experiences with violence involving patients or intimate partners and on their proposed nursing care of battered women given 2 vignettes. RESULTS: Seventy percent of participants experienced violence perpetrated by a patient; 40% of the nurses reported violence perpetrated by their intimate partners; and 19% had used force on their partners. Prior assault of a nurse by a patient or partner did not affect the proposed nursing care that would be provided by that nurse to battered women ed patients. Female nurses who committed violence against their intimate partners proposed less nursing care than did those who did not commit violence against their intimate partners for the vignette describing a woman who had received minor injuries. CONCLUSIONS: This study documents the vulnerability of nurses to assault by patients and intimate partners. This vulnerability does not affect their proposed nursing care of battered women. An exception is nurses who themselves commit violence against intimate partners. Findings point to the need to increase safety for nurses in the workplace and provide employee assistance to help nurses confront violence at home.     

Patient‐related violence against emergency department nurses

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.     

Violence in New South Wales emergency departments.

In 1999 the International Council of Nurses recognised workplace violence as a significant issue in nursing. During the same year the Australian Institute of Criminology reported that health was the most violent industry. This study examined the nature and extent of violence in NSW hospital emergency departments. Emergency nurses experienced violent incidents in their department, in the wards and outside the hospital setting. Every respondent (n=266) experienced some form of violence at least weekly. Ninety-two incidents involved lethal weapons. Ninety-two percent of perpetrators were patients or their relatives, however other staff members were also implicated. Non-reporting of violence is an issue as over 70% of incidents were not referred to authorities. Drugs, alcohol and emergency department waiting times are the most significant predisposing factors. Most emergency nurses are not satisfied with the response of administration to violent incidents within hospitals.     

Nurses' understanding of domestic violence

Domestic violence is considered to be an important health care issue world wide. In order to provide appropriate support and treatment to women who have been abused, it is essential that nurses understand and recognise domestic violence. This study aimed to explore nurses' understanding of domestic violence issues utilising a grounded theory approach. A total of 41 emergency nurses was interviewed in selected Australian and Japanese emergency departments. Analysis of data identified six groups of nurse perceivers of domestic violence: nave perceivers, inexperienced perceivers, compassionate perceivers, proactive perceivers, acting perceivers and reluctant perceivers. Findings indicate that the provision of ongoing education and instigation of policy and protocol enable nurses to respond in a structured manner when they encounter women who have been abused. As a result, nurses can contribute to the amelioration of violence in society and enhance the wellbeing of these women.     

The effectiveness of a training program for emergency department nurses in managing violent situations

An Australian Institute of Criminology report (1999) highlighted the health industry as the most violent industry in Australia with registered nurses recording the second highest number of violence-related workers compensation claims, ranking higher than prison and police officers. Workplace violence has become such a common phenomenon that many nurses accept it as a part of nursing. Nurses employed in emergency departments (EDs) are considered to be especially vulnerable to workplace violence. Although there have been a number of studies reporting on the incidence of workplace violence and its consequences upon nurses, to date there have been no empirical studies that have evaluated interventions which are thought to reduce its occurrence and impact. This study investigated the effectiveness of a one-day training program in which ED nurses participated. In particular, their knowledge, skills and attitudes relating to management of workplace violence were examined. Results show that a training program has many positive outcomes which enhance nurses' ability to manage aggressive behaviours. With some basic training, ED nurses can be more prepared to manage violent and potentially violent situations, and by doing so may in fact reduce the incidence of aggression in their workplace by 50%. This has largely been achieved by raising the awareness of ED nurses to the nature of the problem, developing their knowledge and skills in managing aggressive behaviour, and improving their attitudes toward potentially violent patients.     

Nurses and workplace violence: nurses' experiences of verbal and physical abuse at work

This paper describes nurses' experiences of violence and abuse in the workplace and the ways in which those experiences influence their abilities to care for patients. The original purpose of the research from which these findings derive was to explore nurses' work with abused women. The qualitative study utilizing a Social Constructivism approach was conducted in two countries: Canada and the United Kingdom. Forty-nine nurses from four clinical areas were interviewed, both in focus groups and individually, about factors influencing their care of abused women. In the course of the original study, the degree of verbal abuse and physical violence that nurses routinely encounter in their work became apparent. It also became clear that abuse against nurses is an important issue that has a significant impact on nurses' abilities to offer effective care. Findings indicated that nurses experience significant threat, frequently in the context of their work, at the hands of patients and their relatives; that verbal abuse is an almost daily occurrence; and that support from other healthcare professionals or from administration in addressing the issue, while improving somewhat, is inadequate. This work has implications not only for nurses' health and safety but also, in the broader sense, for the profession's ability to attract and retain nurses within the healthcare system.     

Assault experiences: Lessons learned from mental health nurses in Taiwan

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in‐service, violence‐prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in‐service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in‐service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.     

Impact of hospital security programmes and workplace aggression on nurse perceptions of safety

Aim To assess how nurses’ perception of their safety and risk of violence was affected by their work environment and whether this perception correlated with their actual risk. Background The work environment has an impact on nurses’ perception of their risk of violence and this perception affects worker productivity, quality, employee retention, worker satisfaction and their actual safety. Methods A cross-sectional survey was conducted in person of 314 emergency department nurses and 143 psychiatric nurses, and assault data was collected from injury logs. Results This study found that nurses in the emergency and psychiatric units differed in their perception of violence and safety. The workplace elements that led to a perception of lower risk of violence were not correlated with a lower rate of injury from violent acts. The nurses’ beliefs about the adequacy of security equipment, security guards and the frequency of verbal abuse were strongly correlated with perceived safety. Conclusion Several factors that influence nurses’ perception of their risk of violence are not well correlated with their actual risk. Implications for nursing management Managers must address workplace elements that affect nurse perceptions because this has an impact on quality and employee retention. They must also address factors that have an impact on the actual risk of violence because this study showed, for the first time, that these may differ from perceptions.     

Violence in hospitals and burnout among nursing staff

BackgroundNursing staff, especially in violence-prone emergency departments (ED), are at high risk of burnout. Frequently experienced violence is expected to have a strong impact on the nursing staff's burnout. This study aimed to examine the differences in the level of burnout between nursing staff who work in the ED and nursing staff who work in other inpatient departments, and its relationship with violence in various hospitals in Israel.MethodA cross-sectional study that utilized a three-part questionnaire: demographic data, degree of burnout, and frequency occurrence of violence events against nurses.Results150 nurses in EDs (N = 75) and inpatient departments (N = 75) were sampled. Significant differences were found between the two groups: Nurses in EDs experienced a higher degree of burnout than nurses in other hospital departments, and the degree of burnout was found to have a positive relationship with exposure to both verbal and physical workplace violence.ConclusionsNursing staff in EDs could develop a high degree of burnout, and exposure to workplace violence could exacerbate it. The physical and emotional safety of the staff is an important aspect in preventing burnout, and creating a secure work environment.     

Pediatric emergency nurses’ workplace violence experiences: A qualitative study

IntroductionWorkplace violence is a crucial problem experienced by health workers who serve at the emergency service. The identification of emergency nurses’ workplace experiences is of importance to the prevention of violence and the development of solutions.PurposeThis study was performed to identify the workplace violence experiences of the nurses working for the pediatric emergency units.MethodA total of 20 nurses who experienced violence at the emergency service participated in the study that was conducted as qualitative research. The data were collected with the semi-structured interview form and were evaluated by using thematic analysis.ResultsFive themes, namely, “the characteristics of violence”, “the causes of violence”, “the approach during/after the violence”, “the consequences of the violence for the person”, and the “consequences of the violence for the profession”, were identified. Nurses stated that they often experienced verbal violence due to patient relatives’ unmet expectations, the failure of patient relatives to understand treatments and practices, and the heavy workload, they endeavored to eliminate violence by trying to communicate with perpetrators of the violence, calling the security staff, and reporting the violence to their managers, and they were individually and professionally affected by the violence.ConclusionNurses are negatively affected by workplace violence. Pediatric emergency nurses should be supported with training programs and policies to be developed for the prevention and solution of violence.     

Innocent or culpable? Meanings that emergency department nurses ascribe to individual acts of violence

Aims and objectives. The purpose of the study was to explore the meaning(s) that emergency department nurses ascribe to acts of violence from patients, their family and friends and what impact these meaning(s) have upon how they respond to such acts. Background. Violence in the health sector is of international concern. In high acuity areas such as emergency departments, nurses have an increased risk of violence. The literature further suggests that violence towards nurses in emergency departments is under‐reported. Design and methods. This study was undertaken in 2005, at a regional Australian Emergency Department with 20 consenting registered nurses. Using an instrumental case study design, both qualitative and quantitative data were generated. Qualitative data were collected using participant observation, semi‐structured interviews, informal field interviews and researcher journaling. Quantitative data of violent events were generated using a structured observational guide. Textual data were analysed thematically and numeric data were analysed using frequency counts. Mixed methods and concurrent data analysis contributed to the rigour of this study. Findings. Emergency department nurses made judgments about the meaning of violent events according to three factors: (i) perceived personalization of the violence; (ii) presence of mitigating factors; and (iii) the reason for the presentation. The meanings that were ascribed to individual acts of violence informed the responses that nurses initiated. Conclusions. The findings show that violence towards emergency department nurses is interpreted in a more systematic and complex way than the current definitions of violence make possible. The meanings given to violence were contextually constructed and these ascribed meaning(s) and judgments informed the actions that the nurses took in response to both the act of violence and the agent of violence. Relevance to clinical practice. Understanding the meaning(s) of violence towards nurses contributes to the discussions surrounding why nurses under‐report violence. Further, these findings bring insights into how nurses can and do, handle violence in the workplace.     

Workplace violence against nurses – Prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study

Purpose/objectivesTo determine the prevalence of workplace violence and explore the role of hospital organizational characteristics and health promotion efforts in reducing hospital violence among nurses in Taiwan.DesignCross-sectional survey.SettingOne hundred hospitals across Taiwan.SampleThe final sample in our study comprised responses from 26,979 nurses.MethodsThe data were obtained from a nationwide hospital survey, Physical and Mental Health and Safety Needs in Full-Time Health Care Staff, which was developed and conducted by the Bureau of Health Promotion, Taiwan, in 2011.Main research variablesThe main dependent variable was whether nurses had experienced violence within the past year. Physical violence, threatened or intimidated personal safety, verbal violence or sexual harassment were all included.FindingsOf the 26,979 nurses, 13,392 nurses (49.6%) had experienced at least one episode of any type of violence in the past year; 5150 nurses (19.1%) had been exposed to physical violence, and 12,491 nurses (46.3%) had been exposed to non-physical violence. The prevalence of having experienced any violence varied widely and ranged from the highest (55.5%) in an emergency room or intensive care unit to the lowest (28.3%) among those aged 55–65 years. After adjusting for other characteristics, younger nurses were significantly more likely to be exposed to any violent threat. Nurses working in public hospitals had a significantly higher risk of workplace violence than those working in private hospitals. Significant variations were also observed among work units. Although nurses working in a certified health promoting hospital (HPH) did not have a lower risk of workplace violence, those working in an outstanding HPH had a significantly lower risk of workplace violence. A similar pattern was observed for non-physical violence.ConclusionsWorkplace violence is a major challenge to workplace safety for nurses in hospitals. This large scale nurse survey identified individual, work and hospital characteristics associated with workplace violence among hospital nurses. Preventive efforts in reducing hospital violence shall be targeted these high risk groups and settings.Implications for nursingThis nationwide nurse survey assisted us in more clearly understanding the scope of the hospital violence facing nurses and identifying critical risk factors. The findings not only identified the most common locations of violence in hospitals but also suggested that extensive investments and efforts by hospitals in health promotion are crucial.     

Violence: part of the job for Australian nurses?

According to a recent Australian Institute of Criminology report (1999) the health industry is the most violent industry in Australia. In this paper the authors aim to highlight violence as an important professional issue for Australian nurses that is currently concealed as 'part of the job'. National and international studies bring attention to the severity of the problem for nurses with a particular focus on emergency nurses. Some of the issues identified and discussed include increased waiting times and frustration; increasing use of weapons; inadequate systems of security; culture of silence; inadequate support for emergent mental health needs; lack of reporting; lack of institutional concern and systems of support, and; demands of triage nursing. The nature of workplace violence in emergency departments in New South Wales and South Australia will be explored based on the authors' research. A research pathway to explore national impact and implications of violence for nurses and nursing practice in general will be outlined.     

Rural nurses' safeguarding work: reembodying patient safety

Practice-based evidence includes research that is grounded in the everyshift experiences of rural nurses. This study utilized institutional ethnography to reembody the work of rural nurses and to explore how nurses' work experiences are socially organized. Registered nurses who work in small acute care hospitals were observed and interviewed about their work with the focus on their experiences of providing maternity care. The safeguarding work of rural nurses included anticipating problems and emergencies and being prepared; careful watching, surveillance, and vigilance; negotiating safety; being able to act in emergency situations; and mobilizing emergency transport systems. Increased attention to inquiry about safeguarding as an embodied nursing practice and the textual organization of the work of rural nurses is warranted.