Patient-related violence at triage: A qualitative descriptive study
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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