Nursing Review Issue 3 May-June 2022 - Page 8

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Any number is too high

The extent of violence against ED nurses revealed in new survey .
By Elise Hartevelt

Some emergency department nurses are suffering with PTSD after routinely experiencing high levels of verbal and physical violence , according to a James Cook University survey .

Fourteen nurses at a major rural hospital in NSW told the researchers that they expect to go to work searching patients for weapons and to be touched inappropriately . Lead author and research officer Alycia Jacob said it ’ s a “ persistent and concerning problem ,” where around 95 per cent of health care workers globally are impacted by violence from patients .
“ Violence at a rural ED has become the new normal ,” said Jacob . “ It occurs regularly and has a significant impact on staff .
“ Tolerating and being able to manage violence has become a rite of passage .”
Violence against health care workers can be subjective , making it hard to say what behaviour crosses the line .
They can never be a 100 per cent sure when behaviour is unacceptable , said Jacob .
“ One of the difficulties is around categorising what the actual definition of aggression is .
“ Nurses may not feel like they ’ re actually right in saying whether that ’ s
6 | nursingreview . com . au aggression , ‘ if they say the f-word , is that too much ?’.
“ In some cases , people who turned up were already aggressive before they got to the hospital , [ leaving nurses to manage ] an issue that started in the community .”
Repeated exposure to violence has serious psychological and physical health implications .
Nurses who were regularly subjected to violence were two to four times more likely to develop PTSD , anxiety and depression , a 2021 study found .
They are also more likely to normalise violent encounters in an effort to cope , Jacob said .
“ We had a lot of people talking about other people who had PTSD from their experiences , but none of the people that we spoke to actually admitted being impacted themselves .
“ There is no way to cope in a situation like this that ’ s really sustainable because the situation itself is not good .”
Nurses may minimise the incident , where one participant reported that “ the most I ’ ve had was a fractured cheek bone ”.
Others had a knife thrown at them through the triage window or had been hit in the head by an IV pole .
Violence against nurses was not limited to rural or metropolitan areas , though the location impacts ED nurses differently .
They were at higher risk of running into perpetrators on the street in rural areas because of the lower population levels .
“ Tolerating and being able to manage violence has become a rite of passage .
“ It wasn ’ t so much the difference associated with the in-hospital environment ; it was the association with living in smaller communities ,” Jacob said .
“ People had had an aggression incident in the hospital , and then later on , they actually met someone on the street who ’ d been involved in that incident .
“ They refused to wear their uniform on the street because they ’ d be associated with the hospital .”
The survey respondents said interventions are more focused on fixing the issues rather than prevention , and felt education might not be the solution either .
While training can make nurses feel more confident , most felt it put the responsibility on them rather than the perpetrators . “ There is little evidence that staff education , or any other interventions , have a significant impact on reducing the number of violent incidents ,” said Jacob .
“ Violence in healthcare is a societal issue that cannot be solved without a multifactor approach that considers the characteristics of the perpetrators .
“ It needs to be tackled on an organisational and societal level .” ■