The lived experience of violence in accident and emergency

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Abstract

Aim: To investigate the lived experience of violence of nurses in one A&E department.

Rationale: Following an extensive literature review, it was elicited that there was very little evidence of the psychological impact of violence in A&E.

Background/Introduction: Violence in the health service has increased over the last decade associated with a corresponding increase in the published literature on this topic. While violence in A&E departments would appear common, little evidence exists on the psychosocial impact of these incidents on A&E nurses.

Research methods: A qualitative domain using a phenomenological philosophy was utilised. Sampling was of a volunteer nature and data were collected using interview. Nurses were sampled from one major acute hospital in Northern Ireland.

Results: Participants expressed feelings of frustration, anger, and fear. Support from colleagues was greatly valued and lack of feedback from management was cited as being common.

Discussion: Frustration and anger were synthesised into the “why me” principle with nurses not knowing why they were the focus for attack. Violent incidents were associated with a sense of isolation but colleague support developed a sense of belonging.

Conclusions: Whilst a useful insight was provided, more research is essential into this emotive topic.

Introduction

The Accident and Emergency Department acts as the door to a hospital and consequently staff encounter many different types of individuals (Dimond 1994). As an experienced nurse working in the highly charged environment of Accident and Emergency (A&E), violent incidents have both been witnessed and experienced. Newspaper and television accounts would seem to support the author’s experiences by acknowledging the fact that colleagues throughout the profession are experiencing similar incidents.

Through an initial search of the literature, definitions for the terms violence and aggression were located and examined. A common theme running through the literature is the fact that the two words violence and aggression are often used interchangeably. Even some of our most common terms have aggressive connotations, for example, Storr (1970) asserts that terms such as “we attack our problems” or “get our teeth into them” show that aggressive terminology is common in everyday life and even in the very words we use to communicate.

A semantic definition of aggression was that offered by Baron (1977) and states that:

aggression is any form of behaviour directed toward the goal of harming or injuring another who is motivated to avoid such treatment

(Baron 1977, p. 7)

The author proposes that this definition be adopted for use within the study, as it is easily understood and has been frequently cited throughout the literature.

In comparison to aggression, violence is the actual act of inflicting harm on another individual (Breakwell 1995). For this research, the definition offered by Breakwell (1997) has been adopted. This definition is easy to understand and is also widely quoted throughout the literature in this field. For the purpose of this review, incidents of both violence and aggression will be examined in relation to the health service to obtain a fuller understanding of these concepts.

Section snippets

Incidence and potential causes of violence in the A&E Department

As violence within the hospital setting has increased, there has been a corresponding increase in the amount of published material on this topic (Ryan & Poster 1993). Hewitt and Levin (1997) and Rippon (2000) have published extensive literature reviews of violence in the workplace, highlighting the importance of a pro-active approach from Government. A similar governmental approach was called for in the UK and the Health Services Advisory Committee published an advisory document for its staff

Methodology

The aim of this study is to describe and explore Accident and Emergency nurses’ lived experience of violence in the workplace in one major acute hospital in Northern Ireland.

Results and discussion

The interviews provided a vast amount of data. Through reflection and deeper analysis, a greater understanding of the lived experience of violence in A&E has been gained. Three main themes were identified namely:

  • Why me?

  • A sense of isolation.

  • A sense of belonging.

Recommendations and conclusion

From the data analysis and discussion, several recommendations have become apparent. These include increased feedback to staff from management, the possible development of the highly valued colleague support, and the need for future research. Limitations of the study include the possibility of the previously familiar relationship between the researcher and the informants interfering with the data collection and the need for the researcher to bracket prior knowledge on the subject area. The

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