Patient-Related Violence in Emergency Departments: A Research Report

This report examines the critical issue of workplace violence within hospital emergency departments, particularly focusing on the experiences of nurses and other healthcare professionals in Australian hospitals. The study highlights the increasing prevalence of verbal and physical assaults from patients and their families, often underreported due to a normalization of such behavior. The report analyzes several research articles to explore the types of assaults, the impact on nurses' mental and physical well-being, and the consequences for hospital productivity and service quality. Key findings reveal that nurses frequently face threats and harassment, leading to fear, dissatisfaction, and reluctance to work in emergency settings. The analysis also identifies gaps in current research, such as the limited focus on the experiences of clinicians and other healthcare staff beyond nurses. Recommendations include addressing these gaps and implementing strategies to improve the safety and well-being of healthcare professionals in emergency departments. The report offers insights into the relevance and significance of the problem, emphasizing the need for comprehensive solutions to mitigate workplace violence and ensure a safe and productive healthcare environment for all.

Recommendations to address gaps
All the research articles were successful enough in
establishing the fact that nurses and other health
experts and staffs face physical as well as verbal
assaults. However, there was a gap in the
research that only nurses were considered while
interviewing to record responses regarding the
experience of violence in the emergency
departments. If there would be interview for all the
healthcare professionals, then the gap could be
addressed properly. So, if the responses from the
professionals apart from the nurses would have
been taken to find the complete report, it would
produce a wider result which would be more
accurate.
Background
One of the biggest concerns of emergency departments of hospitals across the world is workplace
violence. In the hospitals, the healthcare professionals including the nurses and other staffs become the
victim of verbal as well as physical assaults from the patients and their families also. In the emergency
departments of Australian hospitals it is increasing at an alarming rate. Furthermore, amongst all other
healthcare professionals, nurses are more likely to face workplace violence and verbal abuse from the
patient parties (Gates, Gillespie &Succop 2011). Nurses not only receive physical harassments but also
some threatening that always disrupts their mental peace and creates psychological issues. However,
workplace violence is often kept unreported in the healthcare organizations because nurses are taught
that violence is a part of their work and getting harassed is quite common while dealing with patients.
But, constant assaults and violence affects the normal working of the nurses which in turn reduces the
productivity of the hospitals or the healthcare organizations as productivity is always dependent on the
quality of service. Several studies in this regard have also revealed that emergency departments are the
worst place to get attacked by violence. Again, as these assaults are under-reported, the higher
authority and management do not get aware of this all the time and as a result no actions are taken
from their side (Sato et al. 2013). But, it is very much essential to uproot the problem after an in-depth
analysis in order to improve the service quality of any healthcare organization. The nurses and other
healthcare professionals who are experienced with physical and verbal abuses can play a major role in
disclosing the real cause and which help in the procedure to reduce it.
Relevance and significance of the problem
Nurses and other healthcare professionals is the main pillar of success, reputation and productivity of
any healthcare organization. If nurses cannot give their full potential in their job, then it hampers the
quality of service they provide which in turn affects the reputation of the organization or the hospitals.
Nurses always face various kinds of assaults from the patients and their families and this happens
mostly in the emergency departments of the hospitals. Sometimes, nurses go into trauma out of fear
and they also become reluctant to come into their workplace. Many studies also disclosed that some of
the nurses and other healthcare professionals were seriously attacked by the patients which brought
their life in risk also. With the use of some external weapons, patients attacked nurses and other staffs
even inside the hospital premises whenever they were dissatisfied from any of the services the hospital
provide. The research papers are focussed in finding the types of assaults they receive and how it is
kept under-reported. So, the research question is relevant to the topic and it has a great significance in
finding what types of assaults are hampering the lives of the nurses.
Research question
What are nurses’ experiences of patient-related violence whilst working in the Emergency Department setting?
Five Key Messages
1. In a study, organized in a hospital of Australia, it was found that nurses who receive verbal and small physical violence attack
from the patients and their families sometimes excuse them as they think all these are the part of their job and getting
verbally abused is quite natural. As nurses consider the violence as a common part they do not report against it and as a
result no actions are taken from the authority to resist it. Even, in the interview round of the study, nurses were selective in
describing their experience regarding violence in the emergency department (Hogarth, Beattie and Morphet 2016).
2. According to the report of studies, it is clear that nurses are more likely to experience workplace violence and most of the
assaults occur in the emergency departments where various kinds of patients are admitted with some serious issues.
Nurses not only get harassment from the patients but also they get threatened by their family members. Nurses accepted
that the violence makes them weak and they fear to come to their workplace due to this. Even, they do not get attention
from the higher authority as they do not report against it considering violence as a very much common issue of emergency
department (Han et al. 2017).
3. Studies revealed, nurses always complaint about their safety in the workplace. Nurses are always suffering from
dissatisfaction in their work and they do not want to work alone in the emergency departments of the hospital out of fear of
getting assaulted by the patients and their families. Nurses are seeking help to get rid of their vulnerable situation whilst
working in the emergency departments of the healthcare organizations or the hospitals because they find it fearful in coming
to their workplace. The threatening and other verbal abuses they receive from the patients and their families hamper their
mental stability (Wolf et al. 2014).
4. The issue regarding the violence of emergency departments has become a professional issue in all over the world. A
qualitative study organized in an Australian hospital revealed that nurses experienced physical assaults that include slap,
kick as well as hit by the patients. Sometimes dissatisfied patients spat on the nurses also. Even, nurses shared that they
have become used to with the verbal abuses by the patients in the emergency departments. Even, the findings from the
study also disclosed that some patients used external weapons like needles, knives and others in order to attack the nurses
and all other healthcare professionals as they were not satisfied with the service provided by the staffs. Their family
members also were found to be involved in violence in some cases (Pich et al. 2011).
5. Most of the time, amount of assaults increased as it was kept unreported by the victims. The healthcare professionals
considered violence as a common factor of emergency departments and they did not get enough support to report to the
higher authority also. Not only the staffs who were directly associated with the treatment procedure of the patients but also
the other professionals that include hospital administrative and managers who were indirectly involved also got harassed by
the patients and their families (Pich et al. 2011). Working alone in the emergency departments has become a nightmare for
nurses. Working in the hospitals has become an issue due to the presence of this kind of violence. Whenever the patients
were dissatisfied by the service of the staffs they found the way in attacking the staffs and other healthcare professionals
who were directly as well as indirectly associated in their treatment (Han et al. 2017).
Implement and disseminate results for relevant target audiences
Clinicians
From the findings of the primary research articles, it is clear that workplace violence has
become a common and dangerous issue for the healthcare professionals. Even, the
clinicians, who are involved directly in treating the patients, also get attacked if the patients
and their families are not satisfied with the service. Mainly, clinicians who are treating some
serious patients experience violence if the patients are not happy with the treatment
procedure (Phillips 2016). It affects their career, reputation which in turn hampers their
mental balance. From the findings of the analysis, the clinicians will be aware of the risks
associated in dealing with patients.
Relatives
The research articles clearly illustrated how violence in the healthcare organization affects
its internal peace and reputation which leads to less productivity and hampers the quality of
the service they provide also. The other patients who are not involved in the violence also
get affected with the violence by receiving low quality service from the providers. If the
staffs are unwilling to work with full potential then the worst sufferer will be the existing
patients who are under the treatment procedure (Blando et al. 2015). This analysis
provides a clear idea to the relatives of the patients that how the violence can become
responsible for the instability of treatment plan and program.
Patients
Most of the patients, who are not satisfied with the service provided by the hospital or any
other healthcare organization, choose the way of violence as a weapon to protest. Patients
always become aggressive on the nurses and other staffs and use verbal assaults to
protest against any fault of them. All these violence occurrences affect the normal
treatment procedure. Patients not only attack the staffs, nurses or clinicians but also the
managers and administrative officers present in the healthcare organization (Arnetz et al.
2015). It is obvious that patients should have right to protest against any poor quality
service but spreading violence is not a good solution for the hospitals as it hampers the
peace of other patients.
Undergraduate nursing students
Nurses are the worst sufferer due to workplace violence in the emergency departments of
the hospitals. They are directly involved in the patients care and whenever the patients find
any gap or dissatisfaction regarding their service, they attack the nurses. Even, the
assaults are not only confined to verbal assaults, rather, some serious physical violence
also hampers the mental peace of the nurses working in the emergency departments
(Blando et al. 2015). The findings from the analysis also depicted that in some cases,
nurses were attacked with some external weapons by the patients. They also receive
threatening from the families of the patients in many cases. Some, nurses shared their
experience and admitted that the workplace violence making them reluctant in working
alone in the emergency departments of the hospitals. It has become a nightmare for some
of them too. In an American study it has been found that 50% nurses of emergency
departments are experienced with violence and most of them consider it as regularity and
thus it is kept under-reported to the hospital authority. From this analysis of the findings of
research articles, undergraduate nurses can get the idea about the types of violence and
the ways to deal with it (Blando et al. 2015).
Name/ID here
Poster Title here
Four Primary Research References
Hogarth, K.M., Beattie, J. and Morphet, J., 2016. Nurses’
attitudes towards the reporting of violence in the
emergency department. Australasian emergency nursing
journal, 19(2), pp.75-81.
Han, C.Y., Lin, C.C., Barnard, A., Hsiao, Y.C., Goopy, S.
and Chen, L.C., 2017. Workplace violence against
emergency nurses in Taiwan: A phenomenographic
study. Nursing outlook, 65(4), pp.428-435.
Wolf, LA, Delao, AM, Perhats, C.& Plaines, D2014,
‘Nothing changes, nobody cares: Understanding the
experience of emergency nurses physically or verbally
assaulted while providing care’, Journal of Emergency
Nursing, vol. 40, pp. 305-310.
Pich, J, Hazelton, M, Sundin, D.& Kable, A 2011,
'Patient-related violence at triage: A qualitative
descriptive study', International Emergency Nursing, vol.
19, no. 1, pp. 12-19.
What still needs to be known (gaps)
The research articles, which has been analysed consists of many studies
and all of the studies proved the fact that nurses and healthcare
professionals who are working in the emergency department of the hospitals
face various kinds of violence from the patients as well as their families.
Sometimes that violence is limited to verbal but in some cases it has crossed
the limit and resulted in physical violence too. All the papers described
interview and other studies which were organized in the nurses only. The
experienced were recorded from the perspective of nurses and no other
healthcare professionals like staffs, clinicians were involved in the analysis.
The violence in the emergency departments not only affects the life of
nurses but also creates hazards for the clinicians, other staffs as well as
healthcare professionals of any healthcare organization or hospital. It is still
tp be known that what are the exact kind of violence faced by the clinicians
and other healthcare experts in the emergency departments and how other
departments are also affected by the violence is still unknown after the
analysis of the research articles.

Part B (500 words approx) 2018 Assessment 2 Poster Template
The nursing project clearly depicted how workplace violence in the healthcare organizations has increased at an alarming rate and created a major concern for the healthcare
professionals including nurses, staffs, clinicians and other officers also. Many research articles have reviewed the matter of workplace violence for healthcare organizations and all of
them depicted the fact of the harassments in the emergency departments. The staffs and nurses receive verbal abuses from the patients and their families whenever they were not
satisfied with the services they provide (Maguire et al. 2018). Even, the assaults were not limited in the verbal abuses, sometimes, nurses received threatens from the families of the
patients and even they also faced physical harassments that includes kick, hit, spat and others. Nurses stated in the interviews that they not always get support to report to the higher
authority against the violence they receive and also they excuse the patients for their behaviors in many cases. They consider the violence as a part of their work and due to that many
of the incidents are kept under-reported (Morken, Johansen and Alsaker 2015). The findings from the project indicated that a huge risk is associated in the life of nurses whilst working
in the emergency departments of the hospitals. The nurses also become mentally weak and sometimes they express their unwillingness to come to the workplace and they do not want
to work alone in the emergency departments also. From the report of previous studies it has been also found that nurses go into trauma out of fear and it severely hampers their mental
stability which in turn affects the productivity, quality of service as well as reputation of the healthcare organizations or the hospitals. Other patients also become the victim of violence
indirectly as it affects their normal treatment procedure due to the mess in the hospital premises (Speroni et al. 2014). So, these findings from the project help a newly qualified
registered nurse in many ways. It makes the nurses aware of the violence and danger associated in the emergency departments of the hospitals or emergency departments where they
are going to work. Nurses can get mentally prepared about the psychological misbalance due to the threatening from the patient parties. The reports stated that due to lack of support
nurses could not raise their voice against the violence to the hospital authority in many cases if the assaults were lesser in amount. Nurses should report the case of violence to their
higher authority in order to uproot the problem and make the emergency department hassle-free. So, all these findings from the project was sufficient enough to provide a clear idea
about the problems of emergency department regarding workplace violence which will be very much helpful for the nurses before starting their work in the hospitals as well as other
healthcare organizations (Waschgler et al. 2013). After getting aware of the troubles, nurses can become more cautious and dutiful to their work and they will be more active in reporting
the violence action to the higher authority immediately to resolve it. So, the nursing project is very much assistive for the newly qualified registered nurses.

Reference List (do not include your four primary research articles)
Arnetz, J.E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M.J., Russell, J. and Essenmacher, L., 2015. Underreporting of workplace violence: Comparison of self-report and actual
documentation of hospital incidents. Workplace health & safety, 63(5), pp.200-210.
Blando, J., Ridenour, M., Hartley, D. and Casteel, C., 2015. Barriers to effective implementation of programs for the prevention of workplace violence in hospitals. Online journal of issues
in nursing, 20(1).
Gates, DM, Gillespie, GL.&Succop, P 2011, ‘Violence against nurses and its impact on stress and productivity’, Nursing Economics, vol. 29, no. 2, pp. 59-67.
Jiao, M., Ning, N., Li, Y., Gao, L., Cui, Y., Sun, H., Kang, Z., Liang, L., Wu, Q. and Hao, Y., 2015. Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ
open, 5(3), p.e006719.
Maguire, B.J., O'meara, P., O'neill, B.J. and Brightwell, R., 2018. Violence against emergency medical services personnel: A systematic review of the literature. American journal of
industrial medicine, 61(2), pp.167-180.
Morken, T., Johansen, I.H. and Alsaker, K., 2015. Dealing with workplace violence in emergency primary health care: a focus group study. BMC family practice, 16(1), p.51.
Phillips, J.P., 2016. Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), pp.1661-1669.
Sato, K, Wakabayashi, T, Kiyoshi-Teo, H.&Fukahori, H 2013, ‘Factors associated with nurses’ reporting of patients’ aggressive behaviour: A cross-sectional survey’,International Journal
of Nursing Studies, 50: 1368-1376.
Speroni, K.G., Fitch, T., Dawson, E., Dugan, L. and Atherton, M., 2014. Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of
emergency nursing, 40(3), pp.218-228.
Waschgler, K., Ruiz‐Hernández, J.A., Llor‐Esteban, B. and García‐Izquierdo, M., 2013. Patients' aggressive behaviours towards nurses: development and psychometric properties of the
hospital aggressive behaviour scale‐users. Journal of advanced nursing, 69(6), pp.1418-1427.