Managing aggression in the Accident and Emergency Department

Abstract

The aim of this exploratory study was to explore the doctors' and nurses' views on managing aggressive behaviour by relatives and patients to staff at the emergency department (ED). The sample consisted of 49 nurses and 41 doctors working in the ED and a response rate of 58.1% was achieved. Data was collected by means of a self designed postal questionnaire, which was piloted on 4 nurses and 5 doctors that used to work in the ED. The findings show that verbal aggression is more frequently encountered than physical aggression. Furthermore, nurses were more prone to be victims of aggression than doctors and the aggressors were usually relatives and of male gender. Verbal aggression was considered too common to report every time. While reporting of physical aggression was more common as it was considered an unacceptable behaviour. The majority of incidents are mainly reported ·to the police officers on site as nurses and doctors perceive the hospital management not to take reports seriously. Nevertheless, the legal proceedings seem to be inappropriate for the ED nurses and doctors. The main reaction on experiencing verbal aggression was trying to settle the situation and calling for help. While for physical aggression nurses and doctors called for help and walked out rather than tackling the situation themselves. Of all the security measure in place in the local ED, more nurses than doctors knew of the presence of a hospital violence policy. Furthermore, nursing staff considered waiting times whilst the medical staff considered alcohol abuse as the main precipitating factor of aggression. Nurses and doctors understood the importance of training in dealing with aggressive people, yet findings showed a lack of aggression management training especially in doctors. Even though training was regarded a means of reducing aggression in the ED, improving security and public awareness together with instituting a zero tolerance policy were the main suggestions to the problem. ED nurses and doctors seem to lack confidence in dealing with aggressive situations. Moreover, job performance seems to be is considerably affected by aggressive incidents to the extent that the some nurses and doctors even considered leaving the ED or profession altogether as a result of it.