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.     

Violence towards emergency department nurses by patients

Emergency department (ED) violence is a significant problem in many hospitals. This study identified the incidence of violence by patients towards nurses in two EDs. Patient factors related to violence were identified and the circumstances surrounding the violent incident were described. Of the 71 ED nurses who participated, 50 (70%) reported 110 episodes of violence in a five-months period. That is approximately five violent incidents per week. Violence was reported most often on evening shifts (n=41, 37%). The nurses' perceived that the perpetrators of violence were under the influence of alcohol (n=30, 27%) and drugs (n=27, 25%) and displayed behaviours associated with mental illness (n=42, 38%). Nurses in this study were sworn at (n=67, 61%), pushed (n=11, 10%), hit (n=3, 3%), and kicked (n=3, 3%). Identification of trends and patterns of violence is necessary so that better health care planning and service provision as well as effective preventative and safe strategies for nurses in the workplace can be implemented.     

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.     

Screening for and treating intimate partner violence in the workplace.

The WHO has declared that violence is a leading worldwide public health problem with intimate partner violence one of the most common forms of violence against women (2002). Health care providers are frequently among the first to see victims of intimate partner violence and must strive to provide appropriate and effective care to abused women. Violence by intimate partners can be prevented. Occupational health nurses have a unique opportunity to intervene with abused women. Routine screening for intimate partner violence increases the likelihood of violence identification, leading to early intervention that may prevent trauma and injury. Occupational health nurses can foster a caring and confidential workplace where abused women feel safe to disclose the violence in their lives and trust that the nurse will provide treatment. A safe and healthy workplace, where abused women feel comfortable disclosing intimate partner violence and seeking treatment may also protect coworkers from the stress and violence that may potentially affect them. Occupational health nurses need to add screening for and treatment of intimate partner violence to their current health promotion and prevention activities to benefit all employees.     

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.     

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.     

Violence Against Female Student Nurses in the Workplace

Violence, harassment, and bullying in the workplace are not new phenomena. However, the growing epidemic of violence in the health sector workplace is raising great concern among workers, employers, and governmental agencies across Australia, Canada, the United Kingdom, and the United States. National and international literature reveals that the prevalence of violence experienced by graduate and undergraduate female nursing students in the college and workplace settings are largely unknown. Moreover, the prevalence of violence is now recognized as a major health priority by the World Health Organization, the International Council of Nurses, and Public Services International. Even so, the number of nursing personnel affected by this problem continues to rise. A modified self-report online survey was used to ascertain the level of violence experienced by nursing students in their clinical placements. One hundred percent of those surveyed had experienced some type of workplace violence and the perpetrators were most often other staff members followed closely by patients. The American Association of Colleges of Nursing Position Statement recommends that all faculty prepare nurses to recognize and prevent all forms of violence in the workplace. This research seeks to develop practical approaches to better understand and prevent this global public health issue.     

Who would want to be a nurse? Violence in the workplace – a factor in recruitment and retention

In a climate of a declining nursing workforce where violence and hostility is a part of the day-to-day lives of most nurses, it is timely to name violence as a major factor in the recruitment and retention of registered nurses in the health system. Workplace violence takes many forms such as aggression, harassment, bullying, intimidation and assault. Violent acts are perpetrated against nurses from various quarters including patients, relatives, other nurses and other professional groups. Research suggests that nurse managers are implicated in workplace violence and bullying. Furthermore, there may be a direct link between episodes of violence and aggression towards nurses and sick leave, burnout and poor recruitment and retention rates. This paper explores what is known about workplace violence as it affects nurses, and calls for managerial support and policy to act to improve work environments for all nurses.     

医院工作场所暴力与护士心理健康的相关性研究

目的调查护士在医院工作场所遭受暴力的情况,探讨医院工作场所暴力对护士心理健康的影响。方法运用整群抽样的方法,调查遭受深圳市3家综合性医院工作至少1年的护士932名。运用医院工作场所暴力调查表和症状自评量表（SCL-90）调查医院工作场所暴力发生的情况和护士心理健康水平。结果医院工作场所暴力总体发生率为64．3％,其中心理暴力为86．0％、身体暴力为20．9％和性暴力为11．5％。遭受医院工作场所暴力组护士的心理健康总体水平为61．0／64．0分高于未遭受医院工作场所暴力组的护士29．0／40．0分,差异具有统计学意义（Z=-9．734,P〈0．01）;遭受医院工作场所暴力的护士在心理健康9个维度方面得分均高于未遭受暴力的护士,差异有统计学意义（P〈0．01）;护士遭受医院暴力的发生频次越多,其心理健康总体水平得分越高,差异具有统计学意义（P〈0．01）。护士遭受心理暴力的发生频次与心理健康总体水平及各维度得分比较,差异有统计学意义（P〈0．01）;护士遭受身体暴力及性暴力的发生频次与心理健康总体水平及各维度得分比较,差异无统计学意义（P〉0．05）。结论目前护士遭受医院工作场所暴力的总体发生率较高;遭受医院工作场所暴力组护士的心理健康水平较未遭受医院工作场所暴力组的护士低;护士遭受医院暴力的发生频次越多,其心理健康水平越低。     

A Survey of Workplace Violence Across 65 U.S. Emergency Departments

Objectives: Workplace violence is a concerning issue. Healthcare workers represent a significant portion of the victims, especially those who work in the emergency department (ED). The objective of this study was to examine ED workplace violence and staff perceptions of physical safety. Methods: Data were obtained from the National Emergency Department Safety Study (NEDSS), which surveyed staff across 69 U.S. EDs including physicians, residents, nurses, nurse practitioners, and physician assistants. The authors also conducted surveys of key informants (one from each site) including ED chairs, medical directors, nurse managers, and administrators. The main outcome measures included physical attacks against staff, frequency of guns or knives in the ED, and staff perceptions of physical safety. Results: A total of 5,695 staff surveys were distributed, and 3,518 surveys from 65 sites were included in the final analysis. One‐fourth of surveyed ED staff reported feeling safe sometimes, rarely, or never. Key informants at the sampled EDs reported a total of 3,461 physical attacks (median of 11 attacks per ED) over the 5‐year period. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. In multivariate analysis, nurses were less likely to feel safe “most of the time” or “always” when compared to other surveyed staff. Conclusions: This study showed that violence and weapons in the ED are common, and nurses were less likely to feel safe than other ED staff.     

Domestic violence screening and treatment in the workplace.

The purpose of this study was to survey occupational health nurses about their perceived ability to screen for and treat domestic violence in the workplace. Occupational health nurses providing direct care or case management anonymously responded to the mailed Occupational Health Nurses' Survey on Screening for Domestic Violence in the Workplace. Findings indicate that occupational health nurses consider domestic violence screening and treatment to be components of their nursing role, but do not believe they have adequate training to competently care for workers who have experienced domestic violence. The occupational health nurses also did not believe policies existed in their workplace to assist them in treating these workers. Findings from this study can be used as the foundation for domestic violence education, policy development, and intervention research.     

Workplace violence against K-12 teachers: implementation of preventive programs.

Decreasing both workplace and school violence needs to be a priority of individuals, families, communities, and workplaces for the effort to be successful. Key factors associated with school and workplace violence such as parental influences, school staff and police involvement, peer pressure, student influences such as drug and alcohol abuse and a preoccupation with weapons, and the mass media have all been identified as possible factors associated with violence against teachers. In addition, individual student characteristics such as gender, socioeconomic status, and a history of prior violence may play a role. However, none of these factors can be identified or singled out as the reason for violence. Violence against teachers occurs as a result of a combination of these factors. Understanding how these factors interact should be a goal of every community and school. Occupational health nurses have the unique opportunity to partner with communities, school nurses, and the school system to develop effective violence prevention programs. Working in schools is an area of expansion for occupational health nurses. They have the expertise to perform worksite assessments and to identify key areas of weakness throughout the facility. Their expertise in reviewing and analyzing workplace injury data and developing cost effectiveness analysis for proposed interventions is unique. Occupational health nurses also have the skills to network with school officials and other key stakeholders to develop interventions to impact the substantial implications of violence in the schools.     

门诊护士工作场所暴力调查与分析

目的了解门诊护士遭受医院工作场所暴力情况及其心理健康状态。方法采用自设调查问卷和症状自评量表对106名门诊护士遭受工作场所暴力及其心理健康状况进行调查。结果76．42％的门诊护士在过去一年中遭受过工作场所暴力;门诊护士的心理健康状况在各方面症状评分均高于常模（P〈0．01）;遭受工作场所暴力的门诊护士心理状况更差（P〈0．01）。结论门诊护士遭受工作场所暴力的问题较为严重,应加强法律法规、应对工作场所暴力的培训及心理疏导,以有效防范医院工作场所暴力的发生,维护门诊护士的身心健康。     

Incidence,Type, Related Factors,and Effect of Workplace Violence on Mental Health Nurses: A Cross-sectional Survey

OBJECTIVE

Workplace violence and its impact on mental health nurses have yet to be thoroughly explored in China. This study aims to investigate the incidence, type, related factors, and effects of workplace violence on mental health nurses as well as identifying coping strategies.

急诊护士遭受工作场所暴力后心理状况调查分析

目的探讨急诊护士遭受工作场所暴力后的心理健康状况。方法应用症状自评量表（symptom checklist-90,SCL-90）对3所综合医院60名遭受过工作场所暴力后的急诊护士进行问卷调查,并将SCL-90各因子得分与国内常模进行比较。结果遭受工作场所暴力后,急诊护士在躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、精神病性等方面的因子分及总分、总均分均高于常模,均P〈O．01或P〈0．0．5,差异具有统计学意义。结论遭受工作场所暴力后,急诊护士心理健康状况明显差于一般人群,应给予受暴者人文关怀,并采取措施预防和干预工作场所暴力和心理伤害的发生。     

急诊科护士工作场所暴力与职业紧张现状及其相关性分析

目的:探讨急诊科护士工作场所暴力与职业紧张之间的关系,为预防急诊科护士工作场所暴力提供理论依据。方法:采用医院工作场所暴力调查量表和职业紧张目录问卷对广州市5家急诊科护士进行调查。结果:80.2%的急诊科护士在过去一年中遭受过工作场所暴力,其中辱骂、威胁、身体攻击的发生率分别为77.6%、62.0%、22.3%。急诊科护士的职业紧张平均得分为296.62分,职业任务平均得分为132.08分,紧张反应平均得分为67.52分,应对资源平均得分为87.11分。影响工作场所暴力的职业紧张因素从大到小排列依次是工作环境、休闲应对资源、心理紧张反应、任务不适、躯体紧张反应、任务过重、任务冲突。结论:急诊科护士工作场所暴力发生率高,急诊科护士工作场所暴力受职业紧张影响。