Innocent or culpable? Meanings that emergency department nurses ascribe to individual acts of violence

Abstract

Aims and objectives: The purpose of the study was to explore the meaning(s) that emergency department nurses ascribe to acts of violence from patients, their family and friends and what impact these meaning(s) have upon how they respond to such acts.

Background: Violence in the health sector is of international concern. In high acuity areas such as emergency departments, nurses have an increased risk of violence. The literature further suggests that violence towards nurses in emergency departments is under-reported.

Design and methods: This study was undertaken in 2005, at a regional Australian Emergency Department with 20 consenting registered nurses. Using an instrumental case study design, both qualitative and quantitative data were generated. Qualitative data were collected using participant observation, semi-structured interviews, informal field interviews and researcher journaling. Quantitative data of violent events were generated using a structured observational guide. Textual data were analysed thematically and numeric data were analysed using frequency counts. Mixed methods and concurrent data analysis contributed to the rigour of this study.

Findings: Emergency department nurses made judgments about the meaning of violent events according to three factors: (i) perceived personalization of the violence; (ii) presence of mitigating factors; and (iii) the reason for the presentation. The meanings that were ascribed to individual acts of violence informed the responses that nurses initiated.

Conclusions: The findings show that violence towards emergency department nurses is interpreted in a more systematic and complex way than the current definitions of violence make possible. The meanings given to violence were contextually constructed and these ascribed meaning(s) and judgments informed the actions that the nurses took in response to both the act of violence and the agent of violence.

Relevance to clinical practice: Understanding the meaning(s) of violence towards nurses contributes to the discussions surrounding why nurses under-report violence. Further, these findings bring insights into how nurses can and do, handle violence in the workplace.