Violence In Emergency Department Research Articles

Nurses’ Perceptions of the Factors Which Cause Violence and Ways of Preventions in the Emergency Department: A Qualitative Study

Background: Violence has been increasing worldwide. The prevalence of violence in the healthcare sector is continuously rising, and the most vulnerable places for violence is emergency departments due to the critical nature of the workplace environment. Aims: To explore the factors that contribute to violence experienced by nurses, the impact of workplace violence on nurses, and the preventive methods. understanding these issues could enhance the workplace environment and quality of healthcare. Method: A qualitative approach was used with purposive sampling of 15 emergency department nurses at hospitals in Palestine who experienced or witnessed workplace violence. Semi-structured, face-to-face individual interviews were conducted to gain in-depth information about nurses’ experience in relation to workplace violence at emergency departments. All the interviews were transcribed verbatim for thematic analysis. Results: Three major themes were found to present the factors that contribute to violence experienced by nurses. These themes are: Knowledge and attitude related-issues, External-related factors and System-related issues. Four major themes emerged relating to the staff feelings, which are: Feeling overwhelmed, feeling distressed, feeling indignity and feeling helpless and fearful. Study participants offered some prevention methods to decrease workplace violence, and some suggestions to handle violence. Conclusion: Numerous factors contribute to the prevalence of workplace violence in emergency departments. Hospital administrations have to ensure the safety of all employees by using suitable precautions. There is an extensive need for psychological support after violent. In addition, universities have to develop communication, violence and stress management-training courses.

Impact of the presence of a mediator on patient violent or uncivil behaviours in emergency departments: a cluster randomised crossover trial.

Several studies reported that violent behaviours were committed by patients against healthcare professionals in emergency departments (EDs). The presence of mediators could prevent or resolve situations of tension. To evaluate whether the presence of mediators in EDs would have an impact on violent behaviours committed by patients or their relatives against healthcare professionals. Design, settings and participants A 6-period cluster randomised crossover trial was performed in 4 EDs during 12 months. Patients aged ≥18 and their relatives were included. In order to prevent or resolve situations of tension and conflict, four mediators were recruited.Outcome measure and analysis Using a logistic regression mixed model, the rate of ED visits in which at least one act of violence was committed by a patient or their relatives, reported by healthcare professionals, was compared between the intervention group and the control group. A total of 50 429 ED visits were performed in the mediator intervention group and 50 851 in the control group. The mediators reported 1365 interventions; >50% of the interventions were to answer questions about clinical management or waiting time. In the intervention group, 173 acts of violence were committed during 129 ED visits, and there were 145 acts of violence committed during 106 ED visits in the control group. The rate of ED visits in which at least one act of violence was committed, was 0.26% in the intervention group and 0.21% in the control group (OR = 1.23; 95% CI [0.73-2.09]); on a 4-level seriousness scale, 41.6% of the acts of violence were rated level-1 (acts of incivility or rudeness) in the intervention group and 40.0% in the control group. The presence of mediators in the ED was not associated with a reduction in violent or uncivil behaviours committed by patients or their relatives. However, the study highlighted that patients had a major need for information regarding their care; improving communication between patients and healthcare professionals might reduce the violence in EDs. Clinicaltrials.gov (NCT03139110).

Nurse Empowerment through Violence Prevention

Since emergency departments (EDs) are known to be high-risk environments for occupational violence, violence against hospital emergency department (ED) nurses is a serious concern worldwide. A systematic literature review of the variables influencing nurse aggression in emergency departments was the main objective of this study. Ten English-language studies that were published between 2008 and 2022 were included in the review of the literature. The researcher used SpringerLink, Science Direct, Google Scholar, ERIC, and Academic Search Elite to conduct a thorough literature review on the research problem as it was defined. The literature review revealed several factors that affect violence towards nurses in emergency rooms. Rarely have prior research examined all aspects of nurse hostility as well as efficient preventative strategies across different medical wards. The study looked at the prevalence, kinds, causes, and effects of workplace violence in emergency departments. It also looked into themes like the origins of violence, incident management, and institutional violence prevention measures, as well as population and occupational risk variables related to workplace violence in EDs. This thorough assessment is essential since it will increase nurses' professionalism, career advancement, and confidence, ultimately resulting in patient satisfaction.

Emergency Department Violence: A Growing Challenge for Healthcare Workers in Saudi Arabia.

Background Workplace violence in healthcare settings, particularly in emergency departments (EDs), is a critical issue affecting healthcare providers and the quality of patient care. This study's primary aim was to determine the prevalence and types of workplace violence experienced by healthcare workers in Saudi Arabian EDs, assess the physical and psychological consequences of such violence, and explore the factors contributing to its occurrence. Methods Employing a descriptive, cross-sectional research design, the study was conducted in two phases at three hospitals in the Eastern Region of Saudi Arabia. It targeted ED healthcare workers, including physicians, nurses, and support staff. Data were collected via a questionnaire disseminated through social media, addressing incidents of violence, their nature, and subsequent responses. Results The findings indicate a significant incidence of workplace violence in EDs, predominantly involving verbal abuse and physical aggression, mostly initiated by patients' companions. The majority of these incidents occurred prior to patient-physician interaction, with nurses frequently being the primary victims. Although incidents were more often formally reported than informally, a substantial number remained unreported. There was no significant correlation between the experienced violence and variables like working hours or hospital governance. Conclusion The research highlights the urgent need for effective policies and strategies to mitigate workplace violence in healthcare settings in Saudi Arabia. It emphasizes the necessity of implementing comprehensive violence prevention and intervention programs to ensure a safer working environment for healthcare professionals.

The completeness of routine registration of the counterpart in deliberate interpersonal violence in an urban emergency department

Most studies of violence from the health care system lack reliable information about the counterpart, which is important for distinguishing between different types of violence. Since 2014, the emergency department at Odense University Hospital in Denmark has routinely registered information about the counterpart. The purpose of this study was to evaluate the completeness of registering information about the counterpart during routine registration of victims of interpersonal violence in the emergency department. We included 11,200 victims treated at the emergency department 2014–2021. Using the patient registration data, we estimated the proportion of missing information on the counterpart, stratified by age group and gender of the victim as well as type of incident and severity of injury. Information about the counterpart was registered in 91.5 % of all cases. In 43.1 % (CI: 42.2–44.0) of the cases, the counterpart was unknown to the victim, in 24.3 % (CI: 23.5–25.1) the counterpart was an acquaintance, in 10.5 % (CI: 10.0–11.1) the counterpart was a partner, and in 4.2 % (CI: 3.8–4.5) the counterpart was another family member. The proportion of cases with no information about the counterpart varied with gender, age group, time of violence, place of violence, weapon use, and severity of injury. Half of the victims injured with firearms (46.2 %, CI: 30.1–62.8) and one-fourth of the victims injured with knives (25.9 %, CI: 21.9–30.2) did not reveal information about the counterpart. The majority of the victims revealed information about the counterpart, making it possible to analyse different types of violence separately.

Hospital-based violence prevention programmes in South Wales Emergency Departments: A process evaluation protocol.

Addressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs. To understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function. Adopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded. This protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team. Protocol registration ISRCTN: 15286575. Registered 13th March, 2023.

Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses

BackgroundAlthough efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence. MethodsA mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department. ResultsFour key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of ‘toughness’) ConclusionEmergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.

Occupational violence in a tertiary emergency department: A retrospective descriptive study

ObjectiveOccupational violence in emergency departments (EDs) impacts staff and patients. Most hospitals have a response mechanism called a ‘Code Black’ or similar. We aimed to determine the incidence of Code Black activations in a tertiary ED and describe contributory factors, management strategies and adverse events. MethodsDescriptive study in a tertiary ED in South-East Queensland in 2021. Adult patients for who a Code Black had been activated were eligible. Data were obtained from a prospectively collected Code Black database, supplemented with retrospective electronic medical records. ResultsThere were 386 Code Black events. The incidence of Code Black activation was 11.0 per 1000 adult ED presentations. Individuals requiring Code Black activation were 59.6 % male with a mean age of 40.9 years. The primary diagnosis was mental illness related in 55.1 %. Alcohol was a suspected factor in 30.9 %. When Code Black activation occurred, median length of stay increased. Restraint including physical, chemical or both were used in 54.1 % of Code Blacks. ConclusionOccupational violence occurs at a three-fold greater incidence within this ED than reported elsewhere. This study reinforces other literature suggesting an increase in occupational violence, demonstrating the need for dedicated preventative strategies for patients at risk of agitation.

A narrative review of emergency department design strategies to prevent violence against healthcare personnel: an Indian perspective

Workplace violence in hospitals, specifically in emergency departments (ED), has become a growing concern in recent years. This violence can come from patients, their families, or visitors and can take the form of verbal or physical attacks. Preventing violence in EDs can be achieved through design modifications with minimal personnel and infrastructure requirements. Infrastructure design plays a crucial role in reducing the risk of violence. Private lockers should be available at the ED entrance to limit dangerous objects being brought into the department. Furnishings should be fixed to prevent them from being used as weapons, and evacuation should be facilitated through open rows of seating. Positive distractions, such as gardens or natural areas visible through windows, can reduce stress in patients and lower aggression. Ligature points should be eliminated and tamper-resistant items should be provided to reduce dangers in the built environment. The triage desk should be positioned in a secure area with access control and panic buttons available for staff. Hidden exits should be provided in case of violence and emergency exits should open outward and be lockable only from the outside. It seems that preventing violence in EDs requires a combination of management, technology, planning, and physical design. Proper infrastructure design can play a crucial role in reducing the risk of violence, and healthcare professionals, administrators, and architects should be aware of best practices in ED design.

Staff Duress Alarms for Workplace Violence in the Emergency Department: A Mixed-Methods Evaluation

IntroductionComplex personal duress alarms may be implemented as part of a multicomponent approach to preventing and mitigating workplace violence in emergency departments. Evaluation of duress alarms after implementation has been identified as a gap in the literature. The purpose of this quality improvement project was to examine the impact of a duress alarm system on workplace violence and user experience in an urban emergency department. MethodsA comprehensive system evaluation was performed using a mixed-methods approach, which included retrospective data review, key informant interviews, observations, and a survey. Forty clinical staff at an emergency department in North Carolina were interviewed and provided feedback on the duress system. ResultsFindings indicated that the duress system was not associated with a decrease in workplace violence, and that the majority of clinical staff did not even wear the duress alarm. Staff indicated that the primary barriers to use of the alarm were the bulky design of the alarm badge, inadequate education about the alarm device and process, and the lack of a reliable and timely response from security. DiscussionOngoing engagement of clinical staff is critical to the success of health care technology implementations. Staff feedback, periodic re-education, and recurring process evaluations are vital to ensuring the continued relevance of systems, especially when staff safety is the intended purpose.

Evidence-Based Approaches to Mitigate Workplace Violence From Patients and Visitors in Emergency Departments: A Rapid Review

IntroductionThis is a rapid review of the published evidence on the effectiveness of interventions for mitigating workplace violence against staff in hospital emergency departments. Focused on the specific needs of an urban emergency department in Canada, this project sought to address the question, “What interventions have evidence regarding effectiveness for addressing workplace patient/visitor violence toward staff in the emergency department?” MethodsFollowing Cochrane Rapid Review methods, 5 electronic databases (MEDLINE via PubMed, Cochrane CENTRAL, Embase, PsycINFO, CINAHL) and Google Scholar were searched in April 2022 for intervention studies to reduce or mitigate workplace violence against staff in hospital emergency departments. Critical appraisal was conducted using Joanna Briggs Institute tools. Key study findings were synthesized narratively. ResultsTwenty-four studies (21 individual studies, 3 reviews) were included in this rapid review. A variety of strategies for reducing and mitigating workplace violence were identified and categorized as single or multicomponent interventions. Although most studies reported positive outcomes on workplace violence, the articles offered limited descriptions of the interventions and/or lacked robust data to demonstrate effectiveness. Insights from across the studies offer knowledge users information to support the development of comprehensive strategies to reduce workplace violence. DiscussionDespite a large body of literature on workplace violence, there is little guidance on effective strategies to mitigate workplace violence in emergency departments. Evidence suggests that multicomponent approaches targeting staff, patients/visitors, and the emergency department environment are essential to addressing and mitigating workplace violence. More research is needed that provides robust evidence on effective violence prevention interventions.

Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study

IntroductionOccupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). MethodsSince December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. ResultsOverall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DiscussionUsing a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.

Using Space Syntax Analysis to Measure Patient Aggression Risk.

The present study investigates whether space syntax offers appropriate tools for identifying risks of aggression, interventional opportunities, and environmental design strategies to reduce the risk of Type II violence in emergency departments. Although healthcare workers are a relatively small percentage of the U.S. workforce, they sustain almost 75% of workplace assaults. Poor environmental design has been identified as an antecedent to aggression by patients and/or their companions. Guided by Rational Choice Theory, Lifestyle Exposure Theory, Routine Activity Theory, and Crime Prevention through Environmental Design (CPTED), the study uses five visibility graph analysis (VGA) measures: visibility, control, controllability, mean visual depth, and occlusivity. Three U.S. hospital-based emergency departments were selected. First, a VGA was performed on all three layouts. A second VGA was performed after excluding unconnected spaces, and a third was performed on key patient and staff areas. Last, a fourth VGA was conducted after performing physical modifications to the three departments. Statistical analysis revealed significant differences in VGA measures not only between different layouts but also between the original and modified layouts. Specifically, small changes created by architectural features can affect visual access and exposure as measured by space syntax. Alcove-style spaces in key staff areas are also associated with limited visual control of the local environment. Typically, in smaller zones, central staff workstations afford better control of patient spaces. This study shows that space syntax analysis is a useful tool for identifying risks of aggression in hospital spaces and for identifying interventional opportunities.

Psychological impact of workplace violence towards nurses in the emergency department

IntroductionGrowing attention has been drawn to workplace violence in healthcare settings and toward healthcare workers. Emergency departments have always been vulnerable to workplace violence since its is usually associated to working with people in extreme distress. Healthcare workers facing numbers of situation with either verbal or physical abuse may face an impact on their mental health.ObjectivesDescribe the psychological impact of workplace violence towards nurses in the emergency departmentMethodsThis is a questionnaire-based cross-sectional study including nurses working in the emergency department of different hospitals of Tunis. The respondents’ data were collected from March 2022 to September 2022.ResultsWe included 164 nurses. They were mainly women (Sex ratio of 0.6) with a median of age was 30.7±7.6 years. Nineteen nurses had history of one or more mental disorders such as anxiety disorder (12 cases) and depressive disorder (11 cases). All nurses were victim of workplace violence, while most (104 nurses) were witness to at least one act of violence. Study population had different degrees of concern about safety in workplace, 29.8% had little to no concern while 29,9% were mildly concerned and 40.2% were severely concerned for which they felt their security compromised (14.6% often and 12.2% always). Violence in workplace had consequences on the quality of their service for 26.8% of nurses. Many (49.4%) felt prejudice on their mental health contrasting with little resort (14%) to mental health providers. Number of nurses presented nightmares (44 cases), avoidance (56 cases) or flashbacks (48 cases) about workplace violence. Psychosomatic symptoms were described by most of the study population (58.5%) such as throbbing (46 cases), nervousness (56 cases), aches (23 cases), fatigue (29 cases) or non-specific digestive signs (17 cases).ConclusionsWorkplace violence in emergency departments, first interface of the care chain, is a real problem with serious consequences. Healthcare workers are forced to provide care in situations that compromise their health and safety. Implementing a national action plan is essential in order to address this dangerous phenomenon.Disclosure of InterestNone Declared

The Team Is Not Okay: Violence in Emergency Departments Across Disciplines in a Health System.

Healthcare workers, particularly those in the emergency department (ED), experience high rates of injuries caused by workplace violence (WPV). Our goal was to establish the incidence of WPV among multidisciplinary ED staff within a regional health system and assess its impact on staff victims. We conducted a survey study of all multidisciplinary ED staff at 18 Midwestern EDs encompassing a larger health system between November 18-December 31, 2020. We solicited the incidence of verbal abuse and physical assault experienced and witnessed by respondents over the prior six months, as well as its impact on staff. We included responses from 814 staff (24.5% response rate) for final analysis with 585 (71.9%) indicating some form of violence experienced in the preceding six months. A total of 582 (71.5%) respondents indicated experiencing verbal abuse, and 251 (30.8%) indicated experiencing some form of physical assault. All disciplines experienced some type of verbal abuse and nearly all experienced some type of physical assault. One hundred thirty-five (21.9%) respondents indicated that being the victim of WPV has affected their ability to perform their job, and nearly half (47.6%) indicated it has changed the way they interact with or perceive patients. Additionally, 132 (21.3%) indicated experiencing symptoms of post-traumatic stress, and 18.5% reported they have considered leaving their position due to an incident. Emergency department staff suffer violence at a high rate, and there is no discipline that is spared. As health systems seek to prioritize staff safety in violence-prone areas such as the ED, it is imperative to recognize that the entire multidisciplinary team is impacted and requires targeted efforts for improvement in safety.

Safe and Sound: An Improvisational Theater-Based Curriculum and Behavioral Intervention to Address Violence in the Emergency Department

Background: Emergency department (ED) workplace violence has become increasingly prevalent in the United States, warranting the development of legislation, policy, and advocacy to protect health care workers. Solutions to address ED violence remain limited, and staff-oriented trainings often exist as short, one-time didactic sessions, which are not practical nor often applicable to the ED setting. There is a paucity of evidence-based interventions that incorporate behavioral-based training to adequately prepare staff for the complicated, multifactorial presentation of violence in the ED. Objective: This pilot study sought to assess the feasibility of an improvisational theater–based, simulation intervention for health care professionals to address ED violence. Methods: A longitudinal curriculum for ED violence was developed in collaboration with a committee of emergency medicine (EM) faculty, EM simulation experts, hospital security and police personnel, professional theater and improvisational performers, resident physicians, and medical students. This pilot intervention was tailored to new EM residents (n = 25) at a large, urban, academic medical center. Sessions were led by facilitators trained in group facilitation, simulation, and improvisation. Results: Participants felt the curriculum was helpful (82.6%), engaging (91.3%), applicable (73.9%), and enjoyable (82.6%). Participation primarily by residents identifying as female and people of color suggested the efficacy of creative expression and nontraditional modalities in engaging diverse learners. Ninety-five percent of participants expressed interest in future sessions. Conclusions: A multidisciplinary workplace violence intervention leveraging principles of improvisational theater, health equity, organizational psychology, and EM simulation may prove useful in preparing health care professionals for violence in the ED.

Violence against healthcare workers in the emergency departments of Al-Madinah hospitals, Saudi Arabia.

Workplace violence (WPV) directed against healthcare workers (HCWs) in healthcare facilities has always been neglected. These occupational hazards have been investigated in recent times and received greater attention from decision-makers. This study aimed to assess the WPV committed against HCWs in the emergency departments (EDs). All the emergency department (ED) healthcare workers (HCW) in the hospitals of Al-Madinah Province, Saudi Arabia, were invited to participate in this cross-sectional study by completing an online questionnaire during May 15 to August 15, 2020. Information sought included characteristics of the participant and workplace, violence, the participants' responses and emotions, the consequences of the WPV incident, and the level of satisfaction with the management of the WPV incident. Data was analyzed using SPSS; Chi-square test was used to assess the association between WPV and various participant and workplace characteristics. Binary logistic regression analysis performed to identify independent predictors of work place violence. A total of 250 HCW filled the questionnaire. One-third of the participants were victims of at least one violent event, mostly nonphysical. The perpetrators were primarily the patient's companions, and a heavy workload/understaffing or an overcrowded environment was the main cause of the violence. The most frequent reaction was to call the hospital security. The emotions the participants experienced were disappointment, low self-esteem, and sadness. Most victims did not report the WPV incident because they believed that reporting was useless, insignificant, or they were fearful of adverse consequences. The rate of violence in EDs in Al-Madinah hospitals was lower than expected, and only 33.3% of HCWs had experienced a violent incident in the last year. However, there is a substantial margin for interventions to improve the situation and protect the HCWs in the EDs.

Triggers of Workplace Violence in Emergency Departments: A Qualitative Study

Background: Workplace violence has become an alarming phenomenon facing healthcare systems worldwide. Emergency nurses were the most victimized from workplace violence incidents. There is a crucial need for conducting qualitative research addressing the unique contextual factors associated with workplace violence against emergency nurses in Jordan.Purpose: This study aimed to explore circumstances that Jordanian emergency nurses, who were victims of workplace violence from clients and/or their relatives, perceive as provocative for workplace violence events.Methods: A qualitative phenomenological method was used. Purposive sampling was utilized to recruit participants (n=15), who were victims of workplace violence, and working in eight emergency departments distributed over all regions of Jordan. Semi-structured face-to-face interviews were conducted. All interviews were recorded and transcribed into Arabic. The Interpretive Phenomenological Analysis (IPA) was used to manually analyse the gathered data. Member checking, prolonged engagement with data, stepwise replication, and personal journaling were used to enhance the rigor of the study.Results: Findings of this study resulted in four superordinate themes that represents the main individual, social, and organisational factors contributing to workplace violence in Jordanian emergency departments. These themes include aggressors’ misconceptions and misbehaviours with four subordinate themes, inappropriate Jordanian social customs with two subordinate themes, organisational circumstances of emergency department with two subordinate themes, and escalator nurses with three subordinate themes.Conclusion: This study highlighted how specific social, cultural, legal, and administrative aspects of Jordanian society were inappropriately employed so as to lead to spread of the workplace violence. This study has provided insight into the need for change at personal level of emergency nurses, social level of Jordanian public, and organizational level of hospital administration and environment in order to mitigate workplace violence incidence in emergency departments.

The Lived Experience of Workplace Violence Among Emergency Nurses

IntroductionWorkplace violence remains a significant threat to the United States health care workforce. With increasingly aggressive patients, emergency nurses reported that the increased prevalence of workplace violence impacted their professional and personal lives. MethodsThis study employed a qualitative, descriptive phenomenological approach with purposive sampling. Participants were asked to describe their lived experience with workplace violence while working as emergency nurses and how this affected them personally and professionally. ResultsEleven experienced emergency registered nurses from 3 mid-Atlantic hospitals participated in the study. After reviewing, clustering, and validating significant statements, 4 major themes were identified: walking wounded to wounded healer, unexpected shock, betrayal, and resilient but changed. DiscussionOur findings were consistent with other studies exploring the effects of workplace violence in emergency departments. We validated that trauma has long-lasting effects. Organizations should ensure that programs and processes are in place to support the nurse or health care worker when workplace violence events occur.

Perpetrator and situational characteristics associated with security alerts in regional Australian emergency departments

BackgroundWorkplace violence is a regular feature of emergency departments (ED) and reported to be increasing in frequency and severity. There is a paucity of data from regional EDs in Australia. The aim of this study was to identify the perpetrator and situational characteristics associated with security alerts in regional emergency departments.MethodsThis retrospective descriptive study was conducted in two regional Australian hospital EDs. All incident reports, hospital summary spreadsheets, and patient medical records associated with a security alert over a two-year period (2017 - 2019) were included. The situational and perpetrator characteristics associated with security alerts in the ED were recorded.ResultsOne hundred fifty-one incidents were reported in the two-year period. Incidents most frequently occurred on late shifts and in an ED cubicle. Most incidents included multiple disciplines such as ED staff and paramedics, police and psychiatric services. One hundred twenty-five incidents had sufficient information to categorise the perpetrators. Mental and behavioural disorders (MBD) were the most frequent perpetrator characteristic present in security alerts (n = 102, 81.6%) and were associated with increased severity of incidents. MBDs other than psychoactive substance use (PSU) were associated with 59.2% (n = 74) of incidents and 66.7% (n = 18) of injuries. PSU was associated with 42.4% (n = 53) of incidents. Following PSU and MBDs other than PSU, repeat perpetrators were the next most prominent perpetrator category (24.8% n = 31) and were almost always associated with an MBD (93.5% n = 29).ConclusionsViolence incidents in the ED are often complex, patients present with multiple issues and are managed across disciplines. Interventions need to extend from one size fits all approaches to targeting specific perpetrator groups. Since MBDs are one of the most significant perpetrator factors, interventions focussing on this characteristic are needed to address workplace violence in EDs.