The consequences of violence against nurses working in the emergency department: A qualitative study
Introduction
Workplace violence (WPV) is one of the most challenging issues in healthcare organizations worldwide [1]. WPV can be defined as “An act of aggression directed toward persons at work or on duty, ranging from offensive or threatening language to homicide” [2,p. 9]. WPV is commonly understood as “any physical assault; emotional or verbal abuse; or threatening, harassing or coercive behavior in the work setting that causes physical and/or emotional harm.” [2,p. 9]. Nearly 25% of violent incidents such as physical violence, verbal abuse and sexual harassment, happen in health care systems [3] and the probability of healthcare personnel experiencing violence is 16 times more than employees in other fields [4].
A high prevalence of WPV in health care systems has been reported all over the world such as 30% in USA [5], 9.5% in England [6], 36.4% in Japan [7], 91.4% in Jordan [8], 67.4% in Saudi Arabia [9], 85.2% in Turkey [10], and 66.8% in China [11]. Violence against nurses has been described as a silent epidemic that leads to serious consequences such as life-threatening injuries and post-traumatic stress disorders [12], [13]. Healthcare work environments with the highest risk for WPV are emergency departments (EDs), psychiatric and intensive care units [1]. Many recent studies reported that the incidence of violence in EDs is growing increasingly around the world, including in Iran [14], [15], [16], [17]. A recent survey conducted in Iran reported that 91.6% of nurses in teaching hospitals experienced verbal assault and 19.7% experienced physical violence during a one-year period [15]. The Emergency Nurses Association (ENA) developed a position statement. It discusses about the serious risk of WPV for emergency nurses, establishing and supporting “zero tolerance” policy; emergency nurses right to personal safety; training; reporting violent incidents; expectations of privacy, proper injury care and professional counseling; protection against violence acts; government regulations to support emergency nurses; and emergency nurses responsibility to participate in research and quality improvement projects aimed at preventing, mitigating and reporting WPV [18,p. 1].
Section snippets
Background
Reviewing the literature revealed that despite of high prevalence and serious consequences of violence against nurses in Iran, the hospitals do not have appropriate policy and laws [14], [19], educational programs [14], [20], adequate security guards [19], [21], appropriate reporting system [19], [20], [21], and zero-tolerance policy [22] to prevent and manage the incidence of violence against Iranian nurses. There is no supporting, consulting and follow-up treatment for staff who experience
Design
Qualitative methods allow for in-depth investigation of individuals’ experiences [27]. Given that WPV and its aftermath is a subjective, multidimensional, and complex phenomenon, a qualitative exploratory design was used to obtain a deep understanding of the phenomenon from nurses’ perspectives. In this study, WPV referred to any physical and/or verbal violence.
Participants
Nurses who work in EDs were recruited from five hospitals in West and East Azerbaijan in Iran. Purposive sampling was used.
Demographic profile of participants
All 16 nurses (9 males and 7 females) experienced violence in the ED. Age of participants ranged from 26 to 44 years (35 ± 5.6 years), Work experience ranged from 2 to 18 years (7.5 ± 3.0 years). Regarding education level, one nurse held a PhD, six had a master’s degree, and the remaining participants held a bachelor’s degree.
Categories
“Suffering nurses” emerged as a main category of the consequences of WPV experienced by emergency nurses. This category had four sub-categories: “mental health risks”, “physical
Discussion
The results of this study showed that nurses in Iran who had experienced violence in the ED complained of mental and physical health problems and described negative effects on their social and professional lives. In line with our results, Lanctôt and Guay reported that the types of consequences of violence against health professionals include psychological, physical, emotional, professional, functional, social, and financial [13]. Our result indicated that WPV disrupt family and colleagues
Conclusions
The findings indicate that nurses who experience WPV suffer from multidimensional consequences. Their physical, mental, social, and professional lives can be affected negatively, which impacts them at home and at work. Thus, serious negative consequences of violence in the workplace put both nurses and patients at risk of serious harmful incidents associated to WPV. The findings from this study can help healthcare managers better understand the consequences of WPV and identify and implement the
Funding
This work was financially supported by the Research Council of Tabriz Medical Science University.
Conflict of interest
The authors report no conflicts of interest.
Author contributions
Study Design: NP, HH, AR, EM. Data Collection and Analysis: NP, HH, AR, EM, JG. Draft Manuscript Writing: NP, HH, JG. Final manuscript review and approval: NP, JG, HH, AR, EM.
Acknowledgements
This article was derived from the PhD dissertation in nursing. Hereby, the authors appreciate and are deeply thankful of all nurses who participated in this research. We wish to also thank Dr. Pat Mayers for her review of the manuscript.
References (41)
- et al.
An epidemic of abuse and violence: nurse on the front line
Accid Emerg Nurs
(2006) - et al.
A survey of violence against staff working in the emergency department in Ankara, Turkey
Asian Nurs Res
(2011) - et al.
The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences
Aggress Violent Behav
(2014) Reducing violence in the emergency department: a rapid response team approach
J Emerg Nurs
(2014)- et al.
Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review
Int J Nurs Stud
(2014) - et al.
Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness
Nurse Educ Today
(2004) - et al.
Frequency and risk factors of workplace violence on psychiatric nurses and its impact on their quality of life in China
Psychiatry Res
(2013) - et al.
The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting. A narrative review of current literature
Nurse Educ Today
(2015) - et al.
Psychological consequences of aggression in pre-hospital emergency care: cross sectional survey
Int J Nurs Stud
(2015) - et al.
Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors
J Emerg Nurs
(2014)
A systematic review of the literature: workplace violence in the emergency department
J Clin Nurs
Emergency Department Violence Surveillance Study
High prevalence of workplace violence among nurses working at public health facilities in Southern Ethiopia
BMC Nurs
Violence in health care. What nurse managers need to know
Nurs Manage
Workplace violence: prevalence and risk factors in the safe at work study
J Occup Environ Med
Risk factors of workplace violence at hospitals in Japan
J Hosp Med
Violence against nurses in emergency departments in Jordan nurses’ perspective
Workplace Health Saf
Violence exposure among health care professionals in Saudi public hospitals. A preliminary investigation
Saudi Med J
Workplace violence and influencing factors among medical professionals in China
Am J Ind Med
Violence against nurses at Public Sector Hospital of Peshawar, Pakistan
Int J Innovative Res Dev
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