BACKGROUND: Violence committed by patients and their families and
visitors against Emergency Department staff in the United States is common
and detrimental to staff well being, morale, and care practices. Hospitals
losses occur due to decreased staff retention, prestige, and patient and
visitor satisfaction.
OBJECTIVE: The purpose of the baseline survey reported here was to
identify and describe staff experiences, concerns, and perceptions related
to violence and abuse perpetrated by patients, family, and non-family
visitors in a Level 1 emergency department.
PARTICIPANTS: The survey sample was composed of 41 registered nurses and
10 paramedics. The majority of the participants (84%, n= 41) were female
and worked full time (82%, n= 41) on the 7P-7A (49%, n= 25) shift.
METHODS: The cross-sectional mixed-method descriptive design used a
survey to measure violence experiences and interviews with key informants.
Specific analytical methods included descriptive and inferential statistics
and ethnography.
RESULTS: The findings are summarized by a model that portrays 1)
Contributing factors to the development of violence in the ED, 2)
maladaptive reactions to workplace violence of Cynicism, Concern for focus
on customer service, and Conflict, and 3) three themes that, depending on
their presence or absence, serve as barriers or facilitators to violence:
Consistency, Consequences and Collaboration.
CONCLUSIONS: Interventions developed to minimize violence in the ED
must focus on modifiable risk factors and address what is in the
department's control including staff education in recognizing escalating
anxious or aggressive behavior, policy development and implementation, and
environmental changes.
