Workplace Violence Faced by Nurses in the Accident and Emergency Department Leads to Anxiety

Introduction

Violence in the workplace faced by the nurse is a major issue worldwide and is increasing at a high rate. Its prevalence is noted by various studies that reflect its severity.

Prevalence of Workplace Violence in Emergency Departments

Global Prevalence of Workplace Violence Against Nurses

The research by Ramacciati et al. (2018) has conducted a qualitative study with the aim to investigate violence against the emergency nurse. They included 15,1628 emergency nurses employed in 668 different Italian National Health Service Accident and Emergency Departments. 39 items questions-based interview was conducted included them for 1 year, among which 1100 nurse responded to the survey and 265 was active in focus questions. The survey analysis noted that all the nurses were having experience of approx. of 11-42 years and all of them have undergone the issue of workplace violence.

Similarly, another research by Hassankhani et al. (2019) included 16 nurses from different five hospitals in Iran for the semi-structured interview. Although the sample size in the study was low, however, all the different nurses from the different hospitals have experienced workplace violence. It indicates the situation of workplace violence is highly common and prevalent in the emergency department.

To support the above finding, the outcome is also evident from the research of Bernaldo-De-Quirós et al. (2015), who undertook a retrospective cross-sectional study including emergency service from 70 different care units in the Madrid region. It included 441 healthcare professionals that comprised of 135 physicians, 179 emergency care assistants and 127 nurses. On investigation related to the psychological issue faced in response to workplace violence, it was noted that approx. 76% of the participants have encountered workplace violence or observed it happening. Therefore, it explicitly explains that workplace violence is highly prevalent worldwide and there is the need to take immediate step to mitigate the issue.

Frequency of Violence in Emergency Departments

Another research by Alyaemni and Alhudaithi (2016) has undertaken a cross-sectional study in the three-emergency department of Riyadh. There was total participation of the 171 nurses including 100 females and 71 males. They all have less than 5 years of experiencing. It noted that 80 participants have experienced workplace violence in less than 12 months, and the rest have encountered the verbal abuse in five years which is yet early when compared to the number of years of experience.

Another similar study by Talas Kocaöz and Akgüç (2011) highlight the high incidence of violence in the emergency department. The researcher has conducted a descriptive study which included 270 staffs working in an emergency based in turkey. They all were interviewed with 36 items questions where the outcome showed that 85.3% of participants have encountered a minimum of one type of workplace violence.

Workplace Violence as a Normalised Part of Nursing

It is more devastating to note that the experience of workplace violence is so frequent that they regard it as part of life and have been used to it. Some nurse take is as part of the job. It is also evident from a study of Ramacciati et al. (2018) where 428 nurses responded workplace violence as the part of duty and 247 nurses responded that since there is the solution to the issue of the violence, they have been used to it. Thus, it shows the most serious issue of the high prevalence of workplace violence in the emergency department.

The high incidence of workplace violence has always been an ignored issue. The analysis of the review found that workplace of violence is common worldwide however, there is no evidence noted that can note the prevalence of the workplace in Singapore, indicating a lack of research in Singapore.

Types of Workplace Violence Experienced by Nurses

Verbal and Physical Abuse in Emergency Departments

The workplace violence faced by the healthcare professional is characterized by verbal abuse, physical abuse and discrimination. The research by Pich, Hazelton and Kable (2013) has conducted a qualitative study that investigated the experience of the Australian nurses working in the emergency department particularly with the young adult patients and parents of the pediatric patient.

Semi-structured interview with the nurses noted that they mainly encountered physical and verbal abuse including threats and swearing. They also reported that it was the daily issue encountered while caring for young adults’ patients. Nevertheless, the situation can be frightening and dangerous as some of the nurses may become injured by the attack of young adults.

It was noted that 11 participants added the usage of opportunistic items and traditional weapons to intimate the nurses. The consequence noted broken nose, wrist injury, damage of ligaments and breaking of thumbs. Thus, it can be said that physical violence was mainly perpetrated by the parents of the pediatric patient in the emergency department, however, such incidence was noted to be intentional or personal.

Aggressive Behaviour and Threats from Patients and Relatives

Compared with the research of Ramacciati et al. (2018), physical and verbal abuse was found by the common type of encountered violence. Another study Lau, Magarey and Wiechula (2012) also noted that aggressive behaviour of patients is highly prevalent in the emergency department.

The most serious issue noted while caring for the young adult (Pich, Hazelton & Kable, 2013). The reported that they threaten them, chased, broke the window and abuse as an act of aggression. Although it is known to leave the nurse frightening and shaken regarding the situation, verbal abuse is potentially more serious as it used to be personal.

Sexual Harassment and Workplace Threats

The study by Talas Kocaöz and Akgüç (2011) has found that 82.5% have faced workplace violence in the emergency department, among which 41.1% encountered physical assault, 55.5% verbal threats, 79.6% verbal abuse and 15.9% sexual harassment.

Similarly, the cross-sectional survey by Alyaemni and Alhudaithi (2016) has also found that 80 nurses have faced verbal abuse, 20 have encountered physical and verbal violence. The study noted that gender and educational qualification was the major factor linked with the type of violence.

Furthermore, the healthcare professional reported that verbal abuse and verbal threats mainly comes from the relatives of the patients and other visitors. It is noted in the research of Alyaemni and Alhudaithi (2016) that 82.4% cases involving patients and 64.8% cases involving relatives and visitor were the common instigator of the workplace violence in the emergency department.

In support of that Lau, Magarey and Wiechula (2012) have noted that due to the uncontrolled situation in the emergency, the aggressive attitude of the relative is common and most prevalent.

Threats to Nurses’ Personal Safety

Most of the healthcare professional reported that most disrespectful type of workplace violence comprises of the threats made by relatives with a combination of weapons like a knife as they approach the nursing staffs. It is noted that such a situation is highly prevalent at the time of the end of visiting hours when the nurse requested them to leave.

A survey and interview with the nurse by Hassankhani et al. (2019) have found that some of the nurses have experienced verbal threats from the relatives saying they know where they live and look for them after their shift hours. This makes them feel unsafe in the healthcare environment.

Causes of Workplace Violence in Emergency Departments

Poor Communication Between Nurses and Patients

Workplace violence is prevalent due to numerous reasons. The literature search has noted several studies that found the cause of workplace violence. Ramacciati et al. (2018) has noted the precipitating factors that trigger workplace violence. It noted that the weak communication skill of the nurse makes the patient irritated as they are unable to understand the issue.

The response by 578 nurses noted that due to the poor communication of the nurses and patient, the act of violence is high prevalence.

Waiting Times and Patient Frustration

The survey also noted that 818 nurses responded that some of the conflicts arise between the nurse and patient due to the different perspective of unsuitable use of the emergency department for non-urgent patients. This makes the relative disrespected and gives rise to verbal abuse.

The finding is supported by Lau, Magarey and Wiechula (2012), where the researcher also noted that cultural and social factors are the other trigger of the violence in the emergency department.

Apart from it, the study has noted that waiting time and ignorance of request by the nurses are the triggering point when the patient becomes violent and aggrieve. The issue of large waiting time is also reported by Ramacciati et al. (2018); Alyaemni and Alhudaithi (2016); and the second part of an investigation by Lau, Magarey and Wiechula (2012).

Lack of Respect Towards Nurses

The research has also noted that discriminating nurse on the basis of the job makes them more vulnerable to workplace violence. On interview, the nurses noted that they are not respected like doctors and their profession allow the patients to behave badly.

Thus, the poor manner, behaviour, attitude, and lack of quality respect for the work of the nurse are the other major reason for workplace violence including verbal abuse and physical abuse.

Organisational and Administrative Failures

The high prevalence of workplace violence is also due to the lack of organizational management and working guideline. As reported by Hassankhani et al. (2019) nurse responded that there is no working guideline in the healthcare sector that could solve the issue of workplace conflict between the nurse and patient or nurse or relatives.

The healthcare professional despite having access to online education, they are ignorant about what needed to be done at the time of violence.

The finding can be compared with the study by Alyaemni and Alhudaithi (2016) where the participants also reported that in the issue of workplace violence, healthcare management does not take any mitigation step.

The finding stated that physical assaults and verbal threats experienced by the nurse were not reported by the manager and incidence estimated to be 43.2% and 65.3% respectively.

Thus, this indicates that the poor administrative factor in the healthcare system gives rise to workplace violence involving verbal and physical abuse.

Psychological and Professional Consequences of Workplace Violence

Anxiety, Stress and Depression Among Nurses

According to the recent review, the high incidence of workplace violence against the nurses has caused them to experience verbal abuse, physical violence and others.

The study by Alyaemni and Alhudaithi (2016) has found that with the prevalence of workplace violence is noted with a negative effect on the nurses. It highlighted that workplace violence not only physically harms the nurse; it poses a huge psychological impact.

The reactions that occurred was anger and sadness. The nurses stated that they could not do anything to solve the issue and it posts a huge burden in the work that outcome with stress and anxiety.

Burnout Syndrome and Emotional Exhaustion

Compared with the finding of Bernaldo-De-Quirós et al. (2015), majority of the healthcare professional has been exposed to the violence like physical and verbal abuses and significantly there was the large number of nurses presented with mental illness like depression, anxiety, burnout syndrome and emotional exhaustion and depersonalization.

The nurse reported that the frequency of the workplace violence was too recurrent in the emergency department, that leads to anxiety and emotional exhaustion five times more than in normal situation.

They also noted that physical aggression is the main type of violence that lead to anxiety whereas verbal aggression causes burnout syndrome.

Impact on Physical Health and Patient Care

The study found that suffering nurse reported mental health risk, physical health risk, the threat to social and personal integrity.

Apart from it, the nurse also reported that due to the mental illness they also experience physical health issues like gastrointestinal problem and headaches.

It also highlighted the victim of workplace violence, low interest in the work, medical error, poor patient care and job dissatisfaction.

Therefore, the research explicitly noted that due to workplace violence, both patient and nurse are negatively impacted.

Feeling Unsafe in the Workplace

The study by Ramacciati et al. (2018) has undertaken a thematic analysis of the finding. Among the themes, the consequence of workplace violence has addressed the mental illness faced by the nurse.

It noted that some nurses feel alone and frustrated as they are not supported in the healthcare organization. They also said that no one does consider the severity of the issue.

When the finding was compared with the outcome of the Pich, Hazelton and Kable (2013), it noted that feeling of unsafe in the working environment due to the violence leads to huge stress and anxiety.

Workplace Violence as a Predictable Yet Preventable Issue

Predictable Violence in Emergency Care

The healthcare professional refers to workplace violence as the daily situation which is not completely prevented.

It is noted in the research of Talas Kocaöz and Akgüç (2011) that early signs of the aggressive attitude of the patient with alcohol abuse or drug abuse are recognised by the nurses as they tend to turn irritated, act angrily and become violent during the care or medication administration.

Lack of Preventive Measures

Despite the fact that some workplace violence is predictable in the healthcare setting, the environment of impulsiveness occasionally pervaded the workplace.

The nurse narrated that they were more suspicious for serving such patients due to the prevalence of the potential threats.

This shows that some of the situations in the healthcare environment are predictable, the preventive measure in the organisational sector is absent.

The situation makes the nurse feel that workplace violence is the part of the job as narrated by some nurse in the research of Ramacciati et al. (2018).

Strategies to Prevent Workplace Violence in Emergency Departments

Improving Communication and Patient Relationships

In order to solve the issue of the workplace violence experienced by the nurse in the emergency department, Lau, Magarey and Wiechula (2012) have noted that there should be empathetic communication skill among the nurses to improve the strained relationship between the nurse and patients and relatives.

Violence Prevention Programs and Staff Training

Hassankhani et al. (2019) stated that violence prevention program should be started that involves administration, staffs, workplace analysis to identify the issue, risk prevention steps and training of the healthcare staffs with continuous monitoring.

Organisational Policies and Guidelines

Ramacciati et al. (2018) added that to improve the working relationship of the patient and nurse and other staffs, a guideline, priority area and principle should be developed to solve the issue of violence.

Psychological Support and Counselling Services

Bernaldo-De-Quirós et al. (2015), noted that to solve the psychological impact due to violence, psychological counselling must be made accessible to proficient staff who have been exposed to verbal violence and physical aggression.

Conclusion

The literature review demonstrates that workplace violence against nurses in accident and emergency departments is highly prevalent worldwide. Nurses frequently experience verbal abuse, physical violence, threats and psychological intimidation from patients, relatives and visitors. The consequences of workplace violence extend beyond physical injuries and significantly contribute to anxiety, depression, burnout syndrome and emotional exhaustion among nurses. Furthermore, organisational failures, poor communication, long waiting times and lack of preventive strategies continue to worsen the issue. Therefore, healthcare organisations must implement effective violence prevention programs, supportive reporting systems, staff training and psychological support services to protect nurses and improve the quality of patient care.