The consequences of violence against nurses working in the emergency department: A qualitative study

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Highlights

  • Nurses who experience WPV complain of mental and physical health problems.

  • Nurses’ social and professional lives were affected negatively after facing WPV.

  • WPV consequences negatively impact nurses and the entire healthcare organization.

  • The serious consequences of WPV ultimately harm patient care.

  • Preventing violence will ensure a safe workplace and safer patient care.

Abstract

Background

Workplace violence (WPV) in healthcare organizations can lead to serious consequences that negatively affect nurses’ lives and patient care. There is limited research on the deeper, underlying consequences of WPV for emergency nurses, particularly among emergency nurses in Iran.

Methods

A qualitative exploratory design was utilized. Semi-structured interviews were conducted with sixteen nurses working in emergency departments in five hospitals in west and east Azerbaijan of Iran. Data were analyzed using conventional content analysis.

Results

“Suffering nurses” emerged as a primary theme of underlying consequences of WPV for emergency nurses. Four sub-themes of suffering were revealed: “mental health risks”; “physical health risks”; “threats to professional integrity”; and “threats to social integrity.”

Conclusion

Emergency nurses suffer from consequences following WPV. These consequences may not be addressed by staff health and safety programs, putting nurses at further risk. The findings of this study can help policy makers, healthcare leadership, and managers better understand the consequences of WPV so they can advocate for and establish WPV prevention programs and support for nurses who have experienced WPV. Preventing violence and providing support for nurses will ensure a safe workplace and safer patient care.

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.

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