Rates of workplace aggression in the emergency department and nurses' perceptions of this challenging behaviour: A multimethod study.
BACKGROUND
Over the last 10 years, the rate of people presenting with challenging behaviour to emergency departments (EDs) has increased and is recognised as a frequent occurrence facing clinicians today. Challenging behaviour often includes verbal aggression, physical aggression, intimidation and destruction of property.


OBJECTIVE
The aim of this research was to (i) identify the characteristics and patterns of ED-reported incidents of challenging behaviour and (ii) explore emergency nurses' perceptions of caring for patients displaying challenging behaviour.


METHODS
This was a multi-method study conducted across two metropolitan Sydney district hospitals. Phase 1 involved a 12-month review of the hospital's incident management database. Phase 2 involved a survey of emergency nurses' perceptions of caring for patients displaying challenging behaviour.


RESULTS
Over 12 months there were 34 incidents of aggression documented and the perpetrators were often male (n=18; 53.0%). The average age was 34.5 years. The majority of reported incidents (n=33; 90.1%) involved intimidation, verbal assault and threatening behaviour. The median time between patient arrival and incident was 109.5min (IQR 192min). The median length of stay for patients was 302.5min (IQR 479min). There was no statistical difference between day of arrival and time of actual incident (t-test p=0.235), length of stay (t-test p=0.963) or ED arrival to incident time (t-test p=0.337). The survey (n=53; 66.2%) identified the average ED experience was 12.2 years (SD 9.8 years). All participants surveyed had experienced verbal abuse and/or physical abuse. Participants (n=52) ranked being spat at (n=37; 71.1%) the most difficult to manage. Qualitative survey open-ended comments were analysed and organised thematically.
The survey identified three themes which were (i) increasing security, (ii) open access and (iii) rostering imbalance.


CONCLUSIONS
The study provides insight into emergency nurses' reported perceptions of patients who display challenging behaviour. All emergency nurse participants reported being regularly exposed to challenging behaviour and this involved both physical and verbal abuse. This was in contrast to a low incident hospital reporting rate. ED clinicians need to be better supported with targeted educational programmes, appropriate ED architecture and reporting mechanism that are not onerous.
Emergency Department, Manly Hospital, Northern Sydney Local Health District, Australia. Electronic address: simone.hyland@health.nsw.gov.au.
Simone
S
Hyland
Emergency Department, Manly Hospital, Northern Sydney Local Health District, Australia. Electronic address: joanne.watts@health.nsw.gov.au.
Joanne
J
Watts
Nursing and Midwifery Directorate, Northern Sydney Local Health District, Faculty of Health, University of Technology Sydney, Australia. Electronic address: Margaret.Fry@uts.edu.au.
Margaret
M
Fry
D000328:Adult; D000374:Aggression / Q000523:psychology*; D001291:Attitude of Health Personnel; D016529:Emergency Nursing / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009517:New South Wales; D010465:Perception; D000066550:Physical Abuse / Q000523:psychology / Q000706:statistics & numerical data; D017132:Workplace / Q000523:psychology / Q000706:statistics & numerical data*
Aggression; Emergency nursing; Health care surveys; Mandatory reporting; Workplace violence