Patient-related violence at triage: A qualitative descriptive study

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Abstract

Aim

The aim of the study was to describe the experiences of a group of triage nurses with patient-related workplace violence during the previous month.

Background

Globally and within the Australian health industry, nurses have been reported to be the occupation at most risk of patient-related violence, with triage nurses identified as a high risk group for both verbal and physical violence.

Method

The study took place in the Emergency Department of a tertiary referral and teaching hospital in regional New South Wales, Australia. Data were collected from August to September 2008, and a qualitative descriptive methodology was employed.

Findings

The participants all reported experiencing episodes of patient related violence that were perceived as inevitable and increasing in intensity and frequency. Themes included identification of precipitating factors such as long waiting times and alcohol and substance misuse. Organisational issues included lack of aggression minimisation training; lack of formal debriefing following episodes of violence and frustration at lengthy reporting processes.

Conclusion

In the context of the Emergency Department where patients present with a range of diagnoses and behaviours, it is unlikely that the issue of patient-related violence can be totally eliminated. However it can be prevented or managed more effectively on many occasions. Strategies to support staff and prevent and manage violence effectively should be a priority to provide a safe working environment and occupational health and safety for staff.

Introduction

Violence in the workplace has been identified as a significant professional issue for nurses globally, and in response the International Council of Nurses published a position statement on violence in 2006, condemning all forms of abuse and violence against nurses (International Council of Nurses, 2006). Aggression and violence have been identified as common features of the modern Emergency Department (ED) (Ryan and Maguire, 2006), with nurses working there estimated to experience violence on a weekly (Crilly et al., 2004), and in some instances daily basis (Ryan and Maguire, 2006). Patients are the most common source of such violence, responsible for upwards of 89% of all incidents (Ryan and Maguire, 2006).

Section snippets

Background/literature review

For the purpose of this study a specific definition of violence, adapted from one used by Mayhew and Chappell (2005), was adopted and provided to participants to ensure consistency in their understanding. It included “any incidents where staff are abused, threatened or assaulted in circumstances relating to their work  involving an explicit or implicit challenge to their safety, well-being or health” (Mayhew and Chappell, 2005, p. 346). Further, it encompassed “any threatening statement or

Aim

The aim of the study was to describe the experiences of a group of triage nurses with patient-related workplace violence during the previous month.

Design and methodology

This study was conducted as part of an honours project. A qualitative descriptive design (Sandelowski, 2000) was selected for the study, and data were collected through the use of semi-structured interviews. This approach facilitated a discovery of nurses’ experiences with patient-related workplace violence, by allowing their true stories to be

Results

Analysis of the transcribed interviews uncovered a number of common themes including identification of precipitating factors such as long waiting times and alcohol and substance misuse; lack of aggression minimisation training; lack of formal debriefing following episodes of violence and frustration at complex reporting methods that were considered to be not “user-friendly”. All participants reported experiencing episodes of patient-related violence that were perceived as inevitable and

Discussion

The results of this study are consistent with the body of literature on the topic. Participants reported experiences with both verbal and physical violence on a regular basis including incidents involving the use of weapons against them. In fact the level of violence is so common that it has become “just part of the job” and is accepted as normal in this ED. This finding is consistent with the literature, for example one Canadian study estimated that 90% of ED nurses were verbally abused in the

Limitations

As only one study site was involved the findings may not be generalisable to other EDs. While the small sample size of six is acknowledged as a limitation, it was appropriate given the time constraints of an honours thesis and the use of a descriptive qualitative methodology.

There is a potential for recall bias due to the design of the study, because participants were asked to describe their past experiences with patient-related workplace violence (Schneider et al., 2004). In an attempt to

Conclusion

Violence in the ED and more specifically at triage is a reality facing modern nurses in their everyday working lives. Whether this trend of increasing violence is unique to the health system or mirroring a similar trend in society is a topic of debate. While system issues such as long waiting times and overcrowding are often cited as contributing factors, there appears to be a lack of commitment on the part of employers, firstly to acknowledge the magnitude and seriousness of the issue and

Conflict of interest

The authors declare that no conflicts of interest exist with regards to this study.

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