Violence in the

Emergency Department

Edward D. Struzinski, RN, CEN, CCRN

IntroductionViolent & aggressive incidents on the rise.Nursing staff in EDs are at much greater risk of harm than those in other areas (Gillam, 2014).“Major portal of entry into healthcare” (Ogundipe, 2013).Unknown, unscreened, unpredictable.Sixty-nine deaths to healthcare workers in four years (Pich, Hazelton, Sundin, & Kable, 2010).

Rippling effects …

Psychological

Post-Traumatic Stress Disorder

Anxiety / Depression

Job stress

Burnout

Job performance and

satisfaction

Leaving Healthcare

DefinitionsNo absolute definition exists due to broad issue.Violence and aggression presents in two forms.

Physical Non-physical

FactorsWaiting times.Anxiety / Frustration.Expectations of care.Alcohol.Mental illness.

Process of conflictDe-humanization – the process of viewing each other as less than human, and therefore undeserving of civilized or otherwise normal treatment or what are generally accepted as fundamentally right (Conflict Research Consortium, 2005).Projecting fault onto opposing individuals.Escalatory spirals (Wilmot & Hocker, 2007).

Fuel for the fireAttitudes.

Untrained individuals.Un-met needs.

Poor communication.Power struggle.

Suddenly .................. Struzinski, E. (2005). Arson watch. [Photograph].

“He needs 10 and 2”

Struzinski, E. (1999). Charles’s Law. [Photograph].

De-sensitizationOverwhelming perception from healthcare workers that violence is an inevitable part of emergency rooms (Pich et al., 2010).

Downplaying of event, minimizing significance.Under-reporting.

Under-reporting

Lack of time (Touzet et al., 2014). Considered waste of time due to unsupportive or administrative response (Pinar & Ucmak, 2011).Apologies from abuser (Taylor & Rew, 2011).Fear of retaliation (Kowalenko, 2013).

Room for improvement?

Training. Security measures.Communication.Leadership and support.

SolutionsEnvironmental considerations.Security/ Police presence – KCMH vs SCH vs YNHH.Video surveillance & personal alarms – BMC vs YNHH. Administrative support.De-escalation training – CHA.

De-escalation Training

Early identification.Recognizing an evolving incident is crucial to helping to prevent it from worsening (Touzet et al., 2014).STAMP acronym for early identification.

Upset individuals often Stare, change their Tone of voice, show Anxiety, Mumble, and Pace back & forth (Pich et al., 2010; Taylor & Rew, 2011).

De-escalation Training

De-escalation begins with a connection.SOLER approach to listening.

Sit squarely. Open posture. Lean forward. Eye contact. Relax framework (Powley, 2014).

Relationship.Understand why individual is acting out.Offer solutions.

ConclusionEmergency Rooms are at greater risk for violent episodes than most other areas.Nurses generally take the hit.Rippling effects.Under-reporting.Training, training, training.

ReferencesConflict Research Consortium, University of Colorado. (2005). Dehumanization. Retrieved from http://www.colorado.edu/conflict/peace/problem/dehuman1.htmGillam, S. (2014). Nonviolent Crisis Intervention Training and the Incidence of Violent Events in a Large Hospital Emergency Department: An Observational Quality Improvement Study. Advanced Emergency Nursing Journal, 36(2), 177-188. doi:10.1097/TME.00000000000000Gillespie, G., Gates, D., Miller, M., & Howard, P. (2012). Emergency department workers’ perceptions of security officers’ effectiveness during violent events. Work, 42(1), 21.-27.Kowalenko, T., Gates, D., Gillespie, G., Succop, P., & Mentzel, T. (2013). Prospective study of violence against ED workers. The American Journal of Emergency Medicine, 31(1), 197-205. doi:10.1016/j.ajem.2012.07.010

ReferencesOgundipe, K., Etonyeaku, A., Adigun, I., Ojo, E., Aladesanmi, T., Taiwo, J., & Obimakinde, O. (2013). Violence in the emergency department: a multicentre survey of nurses' perceptions in Nigeria. Emergency Medicine Journal: EMJ, 30(9), 758-762. doi:10.1136/emermed-2012-201541Pich, J., Hazelton, M., Sundin, D., & Kable, A. (2010). Patient-related violence against emergency department nurses. Nursing & Health Sciences, 12(2), 268-274. doi:10.1111/j.1442-2018.2010.00525.xPinar, R., & Ucmak, F. (2011). Verbal and physical violence in emergency departments: a survey of nurses in Istanbul, Turkey. Journal of Clinical Nursing, 20(3/4), 510-517. doi:10.1111/j.1365-2702.2010.03520.xPowley, D. (2013). Reducing violence and aggression in the emergency department. Emergency Nurse, 21(4), 26-29.

ReferencesStruzinski, E. (2005). Arson watch. [Photograph].Struzinski, E. (1999). Charles’s Law. [Photograph].Taylor, J., & Rew, L. (2011). A systematic review of the literature: workplace violence in the emergency department. Journal of Clinical Nursing, 20(7/8), 1072-1085. doi:10.1111/j.1365-2702.2010.03342.xTouzet, S., Cornut, P., Fassier, J., Le Pogam, M., Burillon, C., & Duclos, A. (2014). Impact of a program to prevent incivility towards and assault of healthcare staff in an ophtalmological emergency unit: study protocol for the PREVURGO On/Off trial. BMC Health Services Research, 14(1), 40-56. doi:10.1186/1472-6963-14-221Wilmot, W., & Hocker, J. (2007). Interpersonal conflict (7th ed.). New York, NY: McGraw-Hill.

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