Several studies indicate that health care providers are increasingly the subject of verbal, psychological and/or physical aggressions. Among them, the Emergency Department nurses, especially if engaged in Triage, are the most vulnerable to acts of violence in the course of their work. Since 2009 I'm investigating the Workplace Violence phenomena in Italian Emergency Departments. With Ceccagnoli and Addy, I conducted literature reviews, qualitative and quantitative studies. We think that only through a comprehensive approach to aggression in the ED we can find an effective response to the problem of violence against nurses. What is your experience about this problem? How can we defend ourselves?
I have witnessed this first hand as triage nurse. In our ED we have our security right in the front of triage which does have a definite effect on calming the overall milleu of triage. Continual observance of any questionable behavior in order to intervene earlier than later has also been very effective in stifling escalating and even combative behaviors.
Investigating any consistent themes of why patients became irritated, aggressive, and combative is also important. Patient perception of long wait-times to see the physician, ED overcrowding, and even lack of information are contributing factors. This is why many of us continually try to improve and expedite the wait times and all of the factors that may cause ED overcrowding as well as prolonged length of stays.
Frequent rounding on patients in triage as well as those patients in the treatment area sends a message of caring, but also increases patient safety, but it also specifically improves patient information. I have also felt that for most patients and families, rapid building of a relationship with the patient sis helpful.
For our behavioral health population, close and even continual observation for any and all patients that raise concern will allow for early detection of any patients which present with any escalating behaviors. As in any other medical condition, early detection and thus early intervention can and most of the time will prevent the disease from escalating.
As far as the question of defending ourselves during a time of an aggressive attack by a patient or a visitor, I feel that defensive tactical maneuvers are warranted but as much as possible without any deleterious affects to the patient. After that said, state legislators in the United States need to reconsider laws regarding assaultive behavior against health care providers. Many states consider an assaultive behavior towards law enforcement, fire fighters, or paramedics a felony wheras assaultive behavior towards physicians, nurses, technicians, or registration personnel merely a misdemeanor providing that the assault does not result in death to that individual.
Thanks Chris, your point of view is very special.
Whenever I hear talk of martial arts or self-defense techniques when it comes to the problem of workplace violence are always very impressed. But many Italian colleagues with whom I was confronted about this issue, I have proposed these defense strategies.
Not a bad idea to give chocolates, we are also thinking of us and then.... I live in a famous Italian city famous for its chocolates (Baci Perugina).
I am increasingly convinced that the solution is not easy, but I hope that seriously addressing the problem one may try to mend the relationship of trust and respect that should characterize the nurse-patient relationship.
Again, thank you.
Regards.
In my opinion, Reinforcement the skilled clinical supervisor in emergency ward Most effective approach to reduce workplace violence.
Thank you for your opinion. But what kind of reinforcement you propose?
Many thanks Ezequiel, your comment is very interesting.
You describe a situation very similar to that of Italy.
Dear Nicola, I attach some of our most recent articles on this topic. Our results indicate that the most frequent hostile behaviors of users are related to the perception of delay in care and lack of information. During this year, we will study in depth the hospitals where there is less aggression frequency patients and those hospitals where there are more problems. We want to identify initiatives already worked in some hospitals to be used in other hospitals. We will use quantitative and qualitative (focus groups) methodology. The medium-term objective is to design a program of proposals that can be tested in some services and, if we find significant changes, implemented in all ED. We are currently finalizing the collection of data in Primary Care centers and we are starting to collect data on mental health services throughout the Region of Murcia (southeast Spain ) .
Regards,
José A. Ruiz
Sorry I can't attach our papers. You can find four articles in my "contributions".
Hi José,
I just read your papers. It's very interesting.
Thank you so much.
Best regards.
Nicola
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