Nurses' Experiences of Patient-Related Violence in Emergency Departments

NURS 3046 Nursing ProjectAssignment 1 (2,000 words 45%)
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Introduction
Workplace violence is a significant stressor for nurses working in Emergency Department settings
worldwide(Gates, Gillespie &Succop 2011). It is estimated that a quarter of all health employees are likely
to experience violent incidents, either verbal or physical, in their direct patient care during their career
(World Health Organization 2016). Globally and within Australia, there is an increasing level of workplace
patient-related violence toward health care workers in Emergency Departments(Sato et al. 2013).Notably,
nurses have been identified as the most at risk health workers to be involved in aggressive situations with
patients or relatives that result in physical injuries and psychological harm(Pich et al. 2011;Hahn et al.
2010).Violence is a significant occupational hazard, but is often under-reported by nurses. Violence
influences nurses’retention, high turnover decisions and reduces nurses’ work productivity (Gillespie, Gates
& Berry2013; Chapman et al. 2009). Studies show that nurses working in Emergency Departments (ED)
experience physical assaults at the highest rate of all nurses (Crilly, Chaboyer, &Creedy 2004).In a US
study, ‘ninety four percent of nurses experienced at least one post-traumatic stress disorder symptom after
a violent event, with 17% having scores high enough to be considered probably for PTSD’ (Gates, Gillespie
&Succop 2011, p. 59). But alarmingly, there is an under-reporting of workplace violence and aggression
which has been attributed, in part, to the poor response by managers to deal with the problem (Wolf et al.
2014). In order to address patient-related violence, it is essential to understand the complexity of the
problem. One aspect is to gain insight into the perceptions of nurses who have experienced violence in the
ED setting.
Research Question: What are nurses’ experiences of patient-related violence whilst working in the
Emergency Department setting?
The research question is highly significant in clinical practice because nurses’ experiences and
coping strategies can provide insightsinto how they cope as they strive to provide person-centred care in a
workplace withescalating levels of patient and relative-related violence (NMBA 2016). Whilst the issue of
workplace aggression in the ED is complex and mulit-factorial, exploring this problem from the nurses’
perspectives is imperative. Findings could inform safe work practices, interventions to prevent patient
aggression, and provide care to ED nurses after such events (Gates, Gillespie &Succop 2011).Findings
could inform strategies that target audiences such as nurse managers and nurses could implementto
improve safety in work environments and occupational health and safety for all. Findings could also be
used by nurse educators to raise awareness and promote effective strategies in the nursing curriculum.
The research question is therefore highly relevant to clinical practice and has wider implications for the
profession and the provision of safe working environments for all nurses working in Emergency Department
settings.
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SUMMARY ANALYSIS OF FOUR (4) PRIMARY RESEARCH ARTICLES (1200 words)
Select four (4) primary research articles (from the 8 articles provided) that provide relevant evidence to
answer the research question. Write a 300 wordsummary of each primary research article using the three
step formatlearned in Topic 2.
Paper 1: Nurses’ attitude towards the reporting of violence in the emergency department
The research paper revealed that the nurses are experiencing workplace violence in the emergency
departments of the hospitals and it is increasing at an alarming rate. It has become a serious
concern for the nurses working in the healthcare organizations. Nurses sometimes become the
victims of violence which may affect their working life as well as result in mental misbalance to.
The paper described that in order to identify the attitude of the nurses regarding workplace
violence, a study was conducted in a large metropolitan emergency department of Melbourne,
Australia according to Maguire et al. (2018 p. 170). All the emergency nurses who experienced
such violence during their working hours were the participants of the study. There were 42
cubicles and 113 full-time nursing staffs in the hospital and all of them participated in the study.
Some semi-structured interview questions were asked of all the participants regarding the violence
they experienced from the patients and their families during their working hours and their
responses were recorded for the further analysis as per Morken et al. (2015 p. 51). Therefore, from
the analysis result, it was clear that although the participants accepted the violence as a part of
their work they all have experienced physical violence and verbal abuse. Participants indicated
that sometimes they received bad behavior from the patients also. The study revealed that they did
not report anywhere for the verbal attacks from the patients who used abusive language to the
nurses. It was found in the study that some of the nurses also excused the patients for their abusive
behavior towards them. As a conclusion after the study, it can be said that nurses reported violence
in their workplaces. Some of them were very much abusive also. But, most of the nurses accepted
the violence as a common issue of the workplace. Nurses were highly selective about the
incidence of violence they experienced whilst working in the emergencies.
Paper 2: Workplace violence against emergency nurses in Taiwan: A phenomenographic study
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In this paper the author stated that different types of workplace violence may occur such as
threatening, physical assault, verbal abuse, harassing and rude behavior also. In an American
study, it has been found that 50% nurses of emergency department become the victim of
workplace violence in a single week as per Pouryaghoub et al. (2017 p. 16). This violence may
occur when a nurse is treating a patient in the emergency department and the family members of
the patient may become aggressive on the procedures of the hospitals and as a consequence,
nurses become the worst sufferers. It is becoming increasingly and the report says that nurses
sometimes beaten, spat on or punched by the family members of the patients. Violence in the
emergency department not only creates a problem for the staffs and nurses but also becomes the
reason for the safety issues of the patients admitted there. The riskiest place for the workplace
violence for nurses is the emergency department and it has been found from many researched that
almost 90% of nurses have experienced such violence which resulted in physical injuries too
according to (Hamdan, 2015). A qualitative study was organized in Taiwan to understand and the
personal and professional responses of the nurses regarding their experience in workplace
violence. In the study, the phenomenographic approach was taken in which many questions were
asked of the participating nurses individually and their responses of experience were recorded for
the further analysis. The nurses who participated in the study were above the age of 20. From the
result it was analyzed that some nurses reported, workplace violence in the emergency department
can sometimes be a direct threat to their life also and even it is an ongoing nightmare for them
(Arnetz et al. 2015 p. 340). Nurses never get support to report such violence and they accept that
as a part of their work. Hospitals of Taiwan are looking to put serious attention for the safety of
their workers.
Paper 3: NOTHING CHANGES, NOBODY CARES: UNDERSTANDING THE EXPERIENCE OF
EMERGENCY NURSES PHYSICALLY OR VERBALLY ASSAULTED WHILE PROVIDING CARE
In the paper, it is mentioned that workplace violence is termed as violent crime and in some recent
studies it has been found that more than 70% nurses of emergency departments experience
workplace violence like threatening, physical as well as verbal assaults and others (Egerton-
Warburton et al. 2016 p. 155). This paper also mentioned that in order to understand the
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experience of the nurses who work in the emergency department and received verbal and physical
assault, a study was organized with the use of a qualitative descriptive exploratory design. 46
English-speaking nurses from Emergency Nurse Association were the participants of this survey
and they sent emails elaborating their experience of violence in their workplace. The participants
were asked to narrate their worst experiences in the mails. All the narratives were reviewed by the
principal investigators. Most of the nurses explored that they work in such an environment where
nobody cares about their safety (Hogarth et al. 2016 p. 80). Some of the nurses said that they
found themselves fearful before coming into their workplaces because they were reluctant to come
into any violent situation. Many nurses find it difficult to work alone as people often behave badly
or loudly. Even they also experience the reaction of post-traumatic patients which makes them cry
too (Wei et al. 2016 p. 65) Sometimes institutes also leave the nurse in vulnerable positions so
they experience much unacceptable behavior from psychiatric patients. The nurses not only
receive verbal abuse but also physical assaults which may result in physical injuries too. From the
qualitative study, it became quite clear that nurses experience severe workplace violence and they
fear to work sometimes. Violence in the emergency department is quite common and it affects the
mental stability of the nurses as well as other healthcare professionals (Hsieh et al. 2016 p. 25).
The nurses are seeking the intervention of higher authorities in order to reduce the workplace
violence so that they can work safely and efficiently to cure the patients which will benefit both
the parties.
Paper 4: Patient-related violence at triage : a qualitative descriptive study
According to the author of the paper, many issues may arise in the workplace and one of them is
workplace violence which is increasing in the emergency departments of the hospitals globally
and due to this the most sufferers are the nurses. This common feature of emergency department
has become a significant professional issue worldwide. In order to describe the experiences of
triage nurses with patient-related violence, a study was organized. Therefore, to conduct the study,
a qualitative descriptive design was selected. Data was collected after the completion of semi-
structured interviews which were conducted on the nurses of the emergency department of a
public hospital situated in New South Wales, Australia. The experiences of a single moth were
recorded in the study (Speroni et al. 2014 p. 220). There were six participants from the age
between 29 to 53 years and it included two male and four female participants. In the interview,
data were recorded in an audio tape for the further analysis by the researchers using qualitative
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