Managing, Mitigating and Minimizing Patient Violence in the Emergency Department

Author

Denise Thompson, Southern Illinois University EdwardsvilleFollow

Date of Award

Spring 5-8-2020

Document Type

DNP Project

Project Team Faculty Member

Dr. Wendy Hochreiter

Keywords

patient violence, nurse violence, emergency room violence, de-escalation, violence prevention

Abstract

Patient violence in the Emergency Department (ED) is common, varied, and has lasting effects on nurses. Survey and questionnaire responses from 18 nurses in a Midwestern hospital ED revealed mindsets and perceptions of short and long term effects of potential and realized patient violence situations. Patient verbal and physical abuse directed at nurses is generally viewed as an acceptable job risk by the general public, hospital administrators, and nurses. Nurse surveys indicated daily anticipation of physical harm, a sense of helplessness from lack of administrative support, and emotional stress related to acts of patient violence. Support from Occupational Safety and Health Administration (OSHA), The Joint Commission, and the Emergency Nurse Association was aimed at protecting nurses physically and emotionally from patient violence through education, empowerment, and encouraging hospital administrative support. ED staff were provided education to manage, mitigate, and minimize patient aggression via a bulletin board. Definitions, literature, statistics, hospital policy and reporting process, and a Crisis Prevention Intervention (CPI) link were easily accessed by ED staff. Pre- and post-education surveys were constructed, distributed, and analyzed to determine changes in nurse knowledge and perceptions related to patient aggression. Sixty nine percent of Registered Nurses completed the pre-questionnaire and 50% completed the post-questionnaire. A prevalent shared theme revealed basic mistrust that hospital administration would respond to reported patient violence. One hundred percent response indicated violence toward nurses was an expectation of the job. Fifty three percent of nurses reported some form of patient violence daily. Presentation of knowledge, new skills, and firm stakeholder support empowered ED nurses to learn to recognize, diffuse, safely react, and report patient violence. Post-project survey and questionnaire results indicated an increased confidence identifying and managing aggressive patients. Overall sense of safety and job satisfaction also increased. However, a "hopeless" belief that reporting violence would result in meaningful change remained. A positive outcome of the project was the hospital administration gained insight to guide future efforts to protect staff as evidenced by requiring patient aggression management technique training. The innovative inclusion of CPI training during the annual nurse competency fair was a clear example of sustainable support for nurse safety.

Recommended Citation

Thompson, Denise, "Managing, Mitigating and Minimizing Patient Violence in the Emergency Department" (2020). Doctor of Nursing Practice Projects. 120.
https://spark.siue.edu/dnpprojects/120

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