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.     

What are the attitudes of coronary care nurses towards the introduction of nurse-initiated thrombolysis?

This study explores nurses' attitudes to the introduction of nurse-initiated thrombolysis, within a large district coronary care unit. A qualitative survey was used to elicit attitudes from all ENB 124 qualified members of staff presently employed within the unit. Concerns expressed by the nursing staff, prior to introduction of this practice, are described. Four key themes emerging from the data are explored; framework for practice; scope for advanced practice; decision-making policy; personal attributes. With the increased introduction of nurse-initiated thrombolysis, further research within this area is advocated.     

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.     

Mental health nurses,promoters of inclusion or perpetuators of exclusion?

The literature identifies that mental health services and those individuals working within them have the potential to facilitate inclusion for their client group, because of their power to initiate potential inclusive opportunities. However, evidence suggests that service users themselves perceive many aspects of mental health services as contributing to the problem of exclusion. This has been attributed to an accumulation of messages, attitudes and disempowering practices that have emanated from mental health care providers over a long period. This study employs focus group methodology in a residential rehabilitation unit in an industrial city in the UK. Discussion of the findings highlight how, in spite of alleged inclusive practices, the attitudes held by members of the unit team could impede the clients' opportunities to become socially included, as a result of defensive practice, paternalistic attitudes, expectations of the local community upon the team and the stagnant views that are embedded in the culture of mental health services. While mental health nurses may see themselves as promoting inclusion, the reality may be quite different.     

Does workplace violence,empathy, and communication influence occupational stress among mental health nurses?

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio‐demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy – Health Professions version, and Nurses’ Clinic Communication Competence Scale were administered to 539 mental health nurses from three top‐grade tertiary research hospitals in the Beijing–Tianjin–Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants’ empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104; P < 0.05) and workplace violence (β = 0.264; P < 0.01) aggravated occupational stress levels, empathy (β = ?0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.     

Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: A qualitative study

There has been an increase in violence and aggression in emergency departments (EDs) in recent years. Among professional health care workers, nurses are more likely than other staff members to be involved in aggressive incidents with patients or relatives. This research study was undertaken to determine nurses’ perceptions of the factors that cause violence and aggression in the ED. Using a qualitative approach, twelve nurses working in an Irish ED were interviewed. Thematic analysis of the interview data revealed that environmental and communication factors contributed to violence and aggression in the ED. Participants perceived waiting times and lack of communication as contributing factors to aggression, and triage was the area in the ED where aggression was most likely to occur. A number of key recommendations arise from the study findings and they all relate to communication. To address the aggression that may arise from waiting times, electronic boards indicating approximate waiting times may be useful. Also, information guides and videotapes on the patient’s journey through the ED may be of benefit. Consideration to the appointment of a communication officer in the ED and communication training for ED staff is also recommended.     

New evidence or changing population? Reviewing the evidence of a link between mental illness and violence

ABSTRACT:  There has been an apparent shift in majority opinion within psychiatry over the last 20 years on the nature of the relationship between mental illness and violence. Where once there was perhaps widespread scepticism , research , while sometimes producing conflicting results , appears ultimately to have led to the emergence of an almost universal consensus that there is a link. This paper will review the nature of the evidence for such a link between mental illness and violence and explore some of the newer suggestions about why mental illness may sometimes be related to violence     

What do nurses do? An observational survey of the activities of nurses on acute surgical and rehabilitation wards

Aim  The subject of the study described in this article is an activity analysis of nursing care given on an acute surgical ward at a District General Hospital as compared to that given on a rehabilitation ward at a Community Hospital.
Methods  Obtaining a global overview of nursing activities on the two study wards was a focal issue. The project consisted of undertaking in excess of 60 h of observation with 10 registered nurses (RNs) of various grades in the two settings.
Findings It was found that both sets of nurses undertook similar types of activities. Overall more indirect care activities than direct care occurred on both wards. These findings are similar to the findings of other studies where the majority of RNs' activities are said to relate to the co-ordinating and management aspects of patient care.
Conclusion  It is concluded that the 'glue function' or maintaining a holistic overview of patient care given by all members of the health care team is an important part of nursing care delivery.     

Sign of the times or the shape of things to come? A 3-day unit of instruction on ‘aggression and violence in health settings for all students during pre-registration nurse training’

In the UK, figures based on a recent survey of NHS Trusts suggest that health-care workers are at greater risk (four times higher than normal) from work related violence than the general population. Studies also show that, of all health professions and grades, student nurses are at the greatest risk of being the victim. Yet, training in self-protection and pro-active management of aggression and violence remains predominantly a post-registration preserve.Despite English National Board (1993) recommendations recognizing that all pre-registration courses for nurses and midwives should contain material on aggression and violence delivered by appropriately qualified trainers and teachers, this input is still likely to be uncoordinated and disparate within curricula.This paper reports the design, and early experience of delivery, of an integrated, 3-day unit of instruction for pre-registration students within a Common Foundation Programme of a diploma-level course. The unit designer/leader is a University Lecturer and Royal College of Nursing (RCN) Institute Registered Trainer in the management of actual and potential aggression. Consequently, all aspects involving teaching physical skills (breakaway skills) adhere to the recently published RCN training standards. In addition, initial student feedback on the delivery and suitability of the unit will be presented, along with a discussion of related issues.