Psychiatric patients presenting to the emergency department can exhibit violence towards nurses. The violence is often due to precipitating factors and underlying mental illness. The nurse must develop mechanisms to prevent violence in the emergency department (Olashore et al., 2018). If unable, the management can establish support strategies. Therefore, this literature review discusses violence against nurses working in the emergency department and preventive strategies.
Review of the Literature
Lawrence et al. (2020) investigated the prevalence of physical assault as a form of violence in the emergency room. This study aimed to investigate the precipitants of violence in the emergency room and the demographic factors associated with violence. This study was quantitative. The study area was a psychiatric emergency unit. In five years, there were 60 incidents of violence against nurses and other healthcare workers. According to Lawrence et al. (2020), the cause of the violence against nurses was a psychiatric illness, the attending nurse’s attitude, prior history of assault, and other exacerbating factors such as non-compliance to therapy. Lawrence et al. (2020) found an association between precipitating factors and violence dues to an odds ratio of 27.860. Lawrence et al. (2020) concluded that there was a need for nurses working in the emergency department to become conversant with the precipitating factors and reduce violence. The precipitating factors are underlying psychotic illness, medication non-compliance, and poor patient-nurse communication.
Okundolor et al. (2021) argue that approximately 25.0% of nurses working in the psychiatric emergency department have been subject to violence more than 20 times. Therefore, Okundolor et al. (2021) recommended strategies to prevent increased incidences of violence against nurses. The strategies aided in diagnosing patients more likely to exhibit violence through a scoring system. The scoring system was called the Harm Score. This score rated patients as having a score more than or equal to five. A score above or equal to five means the patient has a higher chance of becoming violent. The nurses would evaluate the patient using this score by taking a brief history from the relatives or accompanying persons bringing the patient to the hospital. The nurse would then initiate measures to prevent violence, such as pre-medications and a welcoming attitude to the patient, and team drills for very violent patients.
Psychiatric patients are agitated by the delayed delivery of services to the emergency department. Major and VandenBerg (2020) conducted an experimental study to identify the implication of delayed treatment to psychiatric patients in the emergency department. The purpose of delaying treatment was described as boarding, where nurses determine if a patient meets the admission criteria. The holding or withholding of treatment was associated with violence within the emergency department as patients lay on the observation bed (p<0.005). Therefore, to prevent violence in the emergency department, nurses and other healthcare workers were to provide prompt services and treatment to avoid evoking emotions such as bad moods in psychiatric patients.
Acute hospital settings, such as the emergency room, experience more physical violence than other hospital sections. Hence, nurses need to take precautions. Olashore et al. (2018) retrospective study in Sbrana Psychiatric Hospital aimed at locating support strategies for nurses in the emergency department, the prevalence of violence, and precipitating factors. 69.80% of nurses reported having experienced violence, with the major precipitating factor being delayed treatment. The study found no supporting strategies for nurses to avoid violence, such as training. Therefore, healthcare workers must be trained in preventive strategies to prevent violence in the emergency department.
Support and prevention strategies are essential in stopping violence against nurses. Hassankhani et al. (2018) agree with the findings of Olashore et al. (2018) that violence reported at the emergency department by psychiatric health has consequences. The impact of violence was job dissatisfaction, low morale, and assault. The study advocated for policymakers to become aware of the impact of violence and introduce relevant measures to reduce violence. Moreover, a safe workplace will improve the quality of care and patient safety.
Conclusion
The causes of violence at the emergency department are underlying psychiatric illness, the attitude of the attending person, prior history of assault, lack of preventive strategies, delayed treatment, and exacerbating factors such as non-compliance therapy. The effects of violence are job dissatisfaction, low morale, and assault. When these causes are managed, the effects are mitigated, leading to improved quality and safety of care.
The literature reviewed identifies the causes and effects of violence. However, it fails to recommend inclusive strategies for effectively managing and preventing violence at the emergency department. Therefore, preventive strategies form an important study gap for researchers.
References
Hassankhani, H., Parizad, N., Gacki-Smith, J., Rahmani, A., & Mohammadi, E. (2018). The consequences of violence against nurses working in the emergency department: A qualitative study. International emergency nursing, 39, 20-25. https://doi.org/10.1016/j.ienj.2017.07.007.
Lawrence, R. E., Rolin, S. A., Looney, D. V., Birt, A. R., Stevenson, E. M., Dragatsi, D., … & Dixon, L. B. (2020). Physical assault in the psychiatry emergency room. The Journal of the American Academy of Psychiatry and the Law, 48(4), 484. https://doi.org/10.29158%2FJAAPL.200022-20.
Major, D., & VandenBerg, S. (2020). MP59: Exploring adverse events in boarded psychiatric patients in Calgary zone adult emergency departments. Canadian Journal of Emergency Medicine, 22(S1), S64-S64. https://doi.org/10.1017/cem.2020.207.
Okundolor, S. I., Ahenkorah, F., Sarff, L., Carson, N., Olmedo, A., Canamar, C., & Mallett, S. (2021). Zero staff assaults in the psychiatric emergency room: impact of a multifaceted performance improvement project. Journal of the American Psychiatric Nurses Association, 27(1), 64-71. https://doi.org/10.1177/1078390319900243.
Olashore, A. A., Akanni, O. O., & Ogundipe, R. M. (2018). Physical violence against health staff by mentally ill patients at a psychiatric hospital in Botswana. BMC health services research, 18, 1-7. https://doi.org/10.1186/s12913-018-3187-6.
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