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Abstract
RIASSUNTO
Il fenomeno delle violenze sul luogo di lavoro è presente in tutti i contesti lavorativi. Tra questi figurano i dipartimenti di emergenza (DEA), caratterizzati da un ampio numero di accessi quotidiani, da situazioni ad alto contenuto emotivo, e da stress legato alla gestione delle priorití diagnostico-terapeutico-assistenziali. Allo scopo di quantificare il fenomeno delle aggressioni verso gli infermieri dei pronto soccorso, discriminarne tipologie ed perpetratori, ed identificare le conseguenze a livello individuale e organizzativo, è stata condotta una revisione di letteratura sui database Medline, CINHAL, e Medscape. 35 articoli originali inclusi, tra cui è stato possibile reperirne 29. La frequenza degli abusi verbali riportati dagli infermieri operanti nei DEA oscilla tra il 50% ed il 100% degli intervistati nei vari studi, mentre la violenza fisica viene riportata in quote tra il 16.7% ed il 72%. Pazienti e familiari sono ritenuti i principali autori di aggressioni, seguiti in minor parte dai medici, e, solo in basse percentuali, da colleghi di pari grado. L'abuso di alcool, sostanze stupefacenti e l'overcrowding in DEA sono fattori scatenanti degli eventi di violenza. L'under-reporting degli episodi di aggressione è frequente fino all'80% delle vittime, e da alcuni lavori emerge che le aggressioni sono vissute come parte del normale lavoro. E' stata dimostrata una correlazione diretta tra aggressioni e sintomi di disturbo da stress post-traumatico. Inoltre è riportato anche il possibile abbandono del lavoro. Eventi formativi mirati sembrano efficaci per la diminuzione del numero di violenze, e per l'adozione di comportamenti adattivi. Parole Chiave: aggresione, emergenza, violenza, luogo di lavoro.
Aggressions towards nurses in emergency departments: an international literature review
ABSTRACT
Workplace violence is a widespread phenomenon in every kind of settings. Among these ones there are emergency departments (ED), that have distinctive features as like the large daily number of patients' presentations, and high emotional content or stressing situations related to the management of diagnostic-therapeutic priorities. We reviewed the medical and nursing literature to quantify the international widespread of aggressions towards nurses working in EDs, distinguish the typologies and the perpetrators, and identify the consequences on victims and healthcare organizations. Original papers were searched using Medline, CINHAL, and Medscape databases. 35 research articles met the inclusion criteria, but 6 were not retrieved. The rate of verbal abuses reported by ED nurses varies from 50% to 100% of those who were surveyed, while physical violence ranges between 16.7% and 72%. Patients and relatives are the main perpetrators, followed by doctors, and, only in lower percentages, by nurses colleagues. Alcohol, drugs abuse, and overcrowding in EDs are acknowledged as motivating factors for violent events. Under-reporting of aggressions is frequent up to the 80% of victims, and some papers report that nurses consider assaults as a normal part of their work. There is a direct relation between aggressions and symptoms of post-traumatic stress disturb syndrome. Moreover there is a sense of continuous fear in nurses, causing the likelihood of workplace leaving. Special educational courses seem to be effective in diminishing the number of aggressions and to adopt adequate adaptive behaviors.
Key words: aggression emergency nursing, violence, workplace
Dettagli dell'articolo
Riferimenti
- Adeb-Saeedi J. (2002). Stress amongst emergency nurses. Australian Emergency Nursing Journal, 5 (2), 19-24
- Bambi, S, Scarlini, D, Becattini, G, Alocci, P, & Ruggeri, M. (2011). Characteristics of patients who leave the ED triage area without being seen by a doctor: a descriptive study in an urban level II Italian University Hospital. Journal of Emergency Nursing, 37 (4), 334-40
- Becattini, G., Bambi, S., Palazzi, F., & Lumini, E (2007). Il fenomeno delle aggressioni agli operatori di Pronto Soccorso: la prospettiva italiana. XXVI° Congresso Nazionale ANIARTI – Rimini, 24-26 Ottobre 2007. Atti del Congresso.
- Cahill, D.(2008).The effect of ACT-SMART on nurses' perceived level of confidence toward managing the aggressive and violent patient. Advanced Emergency Nursing Journal, 30 (3), 252-70
- Cembrowicz, S.P., & Shepherd, J.P. (1992). Violence in the Accident and Emergency Department. Medicine, Science and the Law, 32 (2),118-22
- CDC Workplace Safety and Health (2002). Occupational hazards in hospital. Data accesso 17 Marzo, 2012. Da http://www.cdc.gov/niosh/pdfs/2002-101.pdf
- Crabbe, J., Alexander, D.A., Klein, S., Walker, S., & Sinclair J. (2002). Dealing with violent and aggressive patients: at what cost to nurses? Irish Journal of Psychological Medicine, 19 (4), 121-4
- Crilly, J., Chaboyer, W., & Creedy D. (2004). Violence towards emergency department nurses by patients. Accident & Emergency Nursing, 12 (2), 67-73
- Deans, C. (2004). The effectiveness of a training program for emergency department nurses in managing violent situations. Australian Journal of Advanced Nurses, 21 (4), 17-22
- Department of Health Western Australia (2004). Prevention of workplace aggression and violence. Data accesso 18 Marzo, 2012. Da http://www.nursing.health.wa.gov.au/docs/reports/WorkplaceAggression_Violence.pdf
- Eslamian, J., Fard, S.H., Tavakol, K., & Yazdani M. (2010). The effect of anger management by nursing staff on violence rate against them in the emergency unit. Iranian Journal of Nursing and Midwifery Research, 15 (Special Issue), 337-342
- Gates, D.M., Gillespie, G.L., & Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29 (2), 59-67
- Gilchrist, H., Jones, S.C., & Barrie, L. (2011). Experiences of emergency department staff: Alcohol-related and other violence and aggression. Australasian Emergency Nursing Journal, 14 (1), 9-16
- Gillespie, G.L., Gates, D.M., Miller, M., & Howard, P.K. (2010). Violence against healthcare workers in a pediatric emergency department. Advanced Emergency Nursing Journal, 32 (1), 68-82
- Kansagra, S.M., Rao, S.R., Sullivan, A.F., Gordon, J.A., Magid, D.J., Kaushal, R., Camargo, C.A. Jr, & Blumenthal, D. (2008). A survey of workplace violence across 65 U.S. emergency departments. Academic Emergency Medicine, 15 (12), 1268-74
- Kwok, R.P., Law, Y.K., Li, K.E., Ng, Y.C., Cheung, M.H., Fung, V.K., Kwok, K.T., Tong, J.M., Yen, P.F., & Leung, W.C. (2006). Prevalence of workplace violence against nurses in Hong Kong. Hong Kong Medical Journal, 12 (1): 6-9
- Jenkins, M.G., Rocke, L.G., McNicholl, B.P., & Hughes D.M. (1998). Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland. Journal of Accident and Emergency Medicine, 15 (4), 262-5
- Lavoie, F.W., Carter, G.L., Danzl, D.F., & Berg, R.L. (1988). Emergency department violence in United States teaching hospitals. Annals of Emergency Medicine, 17 (11), 1227-33
- Luck, L., Jackson, D., & Usher, K. (2007). STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments. Journal of Advanced Nursing, 59 (1), 11-9
- Luck, L., Jackson, D., & Usher, K. (2008). Innocent or culpable? Meanings that emergency department nurses ascribe to individual acts of violence. Journal of Clinical Nursing, 17 (8),1071-8
- Lyneham, J. (2000). Violence in New South Wales emergency departments. Australian Journal of Advanced Nurses, 18 (2), 8-17
- Ministero della Salute (2007). Raccomandazione n. 8 - Raccomandazione per prevenire gli atti di violenza a danno degli operatori sanitari. Data accesso 16 Marzo, 2012. Da http://www.salute.gov.it/ imgs/C_17_pubblicazioni_721_allegato.pdf
- Ministero della Salute (2009). Monitoraggio degli eventi sentinella. Data accesso 16 Marzo, 2012. Da http://www.salute.gov.it/qualita/paginaInternaQualita.jsp?id=238&menu=sicurezza
- Opie, T., Lenthall, S., Dollard, M., Wakerman, J., MacLeod, M., Knight, S., Dunn, S., & Rickard, G. (2010). Trends in workplace violence in the remote area nursing workforce. Australian Journal of Advanced Nursing, 27 (4), 18-23
- Perrone, S. (1999). Violence in the workplace. Australian Institute of Criminology Research and Public Policy Series No. 22. Issue overviews. Data accesso 18 Marzo, 2012. Da http://www.aic.gov.au/documents /4/1/0/%7B410FD288-AD82-4E4E-A6FE-C7C30D283528%7Dfull_report.pdf
- Pich, J., Hazelton, M., Sundin, D., & Kable, A. (2011) Patient-related violence at triage: A qualitative descriptive study. International Emergency Nursing, 19 (1), 12-19
- Pinar, R., & Ucmak, F. (2011). Verbal and physical violence in emergency departments: a survey of nurses in Istanbul, Turkey. Journal of Clinical Nursing, 20 (3-4), 510-7
- Rodger, M., Hills, J., & Kristjanson, L. (2004). A Delphi study on research priorities for emergency nurses in Western Australia. Journal of Emergency Nursing, 30 (2), 117-25
- Rose, M. (1997) A survey of violence toward nursing staff in one large Irish Accident and Emergency Department. Journal of Emergency Nursing, 23 (3), 214-9
- Ross-Adjie, G.M., Leslie, G., & Gillman, L. (2007). Occupational stress in the ED: what matters to nurses? Australasian Emergency Nursing Journal, 10 (3), 117-23
- Ryan, D., & Maguire, J. (2006). Aggression and violence - a problem in Irish Accident and Emergency departments? Journal of Nursing Management, 14 (2), 106-15
- Schnieden, V., & Marren-Bell, U. (1995). Violence in the accident and emergency department. Accident & Emergency Nursing, 3 (2), 74-8
- Tang, J.S., Chen, C.L., Zhang, Z.R., & Wang, L. (2007) Incidence and related factors of violence in emergency departments--a study of nurses in southern Taiwan. Journal of the Formosan Medical Association, 106 (9), 748-58
- The Joint Commission (2010). Preventing violence in the health care setting. Issue 45, June 3. Data accesso 16 Marzo, 2012. Da http://www.jointcommission.org /assets/1/18/SEA_45.PDF
- United States Department of Labor, Occupational Safety and Health Administration (2012). Workplace Violence. Data accesso 17 Marzo, 2012. da http://www.osha.gov/SLTC/workplaceviolence/
- Wilkes, L., Mohan, S., Luck, L., Jackson, D. (2010). Development of a violence tool in the emergency hospital setting. Nurse Researcher, 17 (4), 70-82
- Winstanley, S., & Whittington, R. (2004). Aggression towards health care staff in a UK general hospital: variation among professions and departments. Journal of Clinical Nursing, 13 (1), 3-10
- Zampieron, A., Galeazzo, M., Turra, S., & Buja A (2010). Perceived aggression towards nurses: study in two Italian health institutions. Journal of Clinical Nursing, 19 (15-16), 2329-41
Riferimenti
Adeb-Saeedi J. (2002). Stress amongst emergency nurses. Australian Emergency Nursing Journal, 5 (2), 19-24
Bambi, S, Scarlini, D, Becattini, G, Alocci, P, & Ruggeri, M. (2011). Characteristics of patients who leave the ED triage area without being seen by a doctor: a descriptive study in an urban level II Italian University Hospital. Journal of Emergency Nursing, 37 (4), 334-40
Becattini, G., Bambi, S., Palazzi, F., & Lumini, E (2007). Il fenomeno delle aggressioni agli operatori di Pronto Soccorso: la prospettiva italiana. XXVI° Congresso Nazionale ANIARTI – Rimini, 24-26 Ottobre 2007. Atti del Congresso.
Cahill, D.(2008).The effect of ACT-SMART on nurses' perceived level of confidence toward managing the aggressive and violent patient. Advanced Emergency Nursing Journal, 30 (3), 252-70
Cembrowicz, S.P., & Shepherd, J.P. (1992). Violence in the Accident and Emergency Department. Medicine, Science and the Law, 32 (2),118-22
CDC Workplace Safety and Health (2002). Occupational hazards in hospital. Data accesso 17 Marzo, 2012. Da http://www.cdc.gov/niosh/pdfs/2002-101.pdf
Crabbe, J., Alexander, D.A., Klein, S., Walker, S., & Sinclair J. (2002). Dealing with violent and aggressive patients: at what cost to nurses? Irish Journal of Psychological Medicine, 19 (4), 121-4
Crilly, J., Chaboyer, W., & Creedy D. (2004). Violence towards emergency department nurses by patients. Accident & Emergency Nursing, 12 (2), 67-73
Deans, C. (2004). The effectiveness of a training program for emergency department nurses in managing violent situations. Australian Journal of Advanced Nurses, 21 (4), 17-22
Department of Health Western Australia (2004). Prevention of workplace aggression and violence. Data accesso 18 Marzo, 2012. Da http://www.nursing.health.wa.gov.au/docs/reports/WorkplaceAggression_Violence.pdf
Eslamian, J., Fard, S.H., Tavakol, K., & Yazdani M. (2010). The effect of anger management by nursing staff on violence rate against them in the emergency unit. Iranian Journal of Nursing and Midwifery Research, 15 (Special Issue), 337-342
Gates, D.M., Gillespie, G.L., & Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29 (2), 59-67
Gilchrist, H., Jones, S.C., & Barrie, L. (2011). Experiences of emergency department staff: Alcohol-related and other violence and aggression. Australasian Emergency Nursing Journal, 14 (1), 9-16
Gillespie, G.L., Gates, D.M., Miller, M., & Howard, P.K. (2010). Violence against healthcare workers in a pediatric emergency department. Advanced Emergency Nursing Journal, 32 (1), 68-82
Kansagra, S.M., Rao, S.R., Sullivan, A.F., Gordon, J.A., Magid, D.J., Kaushal, R., Camargo, C.A. Jr, & Blumenthal, D. (2008). A survey of workplace violence across 65 U.S. emergency departments. Academic Emergency Medicine, 15 (12), 1268-74
Kwok, R.P., Law, Y.K., Li, K.E., Ng, Y.C., Cheung, M.H., Fung, V.K., Kwok, K.T., Tong, J.M., Yen, P.F., & Leung, W.C. (2006). Prevalence of workplace violence against nurses in Hong Kong. Hong Kong Medical Journal, 12 (1): 6-9
Jenkins, M.G., Rocke, L.G., McNicholl, B.P., & Hughes D.M. (1998). Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland. Journal of Accident and Emergency Medicine, 15 (4), 262-5
Lavoie, F.W., Carter, G.L., Danzl, D.F., & Berg, R.L. (1988). Emergency department violence in United States teaching hospitals. Annals of Emergency Medicine, 17 (11), 1227-33
Luck, L., Jackson, D., & Usher, K. (2007). STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments. Journal of Advanced Nursing, 59 (1), 11-9
Luck, L., Jackson, D., & Usher, K. (2008). Innocent or culpable? Meanings that emergency department nurses ascribe to individual acts of violence. Journal of Clinical Nursing, 17 (8),1071-8
Lyneham, J. (2000). Violence in New South Wales emergency departments. Australian Journal of Advanced Nurses, 18 (2), 8-17
Ministero della Salute (2007). Raccomandazione n. 8 - Raccomandazione per prevenire gli atti di violenza a danno degli operatori sanitari. Data accesso 16 Marzo, 2012. Da http://www.salute.gov.it/ imgs/C_17_pubblicazioni_721_allegato.pdf
Ministero della Salute (2009). Monitoraggio degli eventi sentinella. Data accesso 16 Marzo, 2012. Da http://www.salute.gov.it/qualita/paginaInternaQualita.jsp?id=238&menu=sicurezza
Opie, T., Lenthall, S., Dollard, M., Wakerman, J., MacLeod, M., Knight, S., Dunn, S., & Rickard, G. (2010). Trends in workplace violence in the remote area nursing workforce. Australian Journal of Advanced Nursing, 27 (4), 18-23
Perrone, S. (1999). Violence in the workplace. Australian Institute of Criminology Research and Public Policy Series No. 22. Issue overviews. Data accesso 18 Marzo, 2012. Da http://www.aic.gov.au/documents /4/1/0/%7B410FD288-AD82-4E4E-A6FE-C7C30D283528%7Dfull_report.pdf
Pich, J., Hazelton, M., Sundin, D., & Kable, A. (2011) Patient-related violence at triage: A qualitative descriptive study. International Emergency Nursing, 19 (1), 12-19
Pinar, R., & Ucmak, F. (2011). Verbal and physical violence in emergency departments: a survey of nurses in Istanbul, Turkey. Journal of Clinical Nursing, 20 (3-4), 510-7
Rodger, M., Hills, J., & Kristjanson, L. (2004). A Delphi study on research priorities for emergency nurses in Western Australia. Journal of Emergency Nursing, 30 (2), 117-25
Rose, M. (1997) A survey of violence toward nursing staff in one large Irish Accident and Emergency Department. Journal of Emergency Nursing, 23 (3), 214-9
Ross-Adjie, G.M., Leslie, G., & Gillman, L. (2007). Occupational stress in the ED: what matters to nurses? Australasian Emergency Nursing Journal, 10 (3), 117-23
Ryan, D., & Maguire, J. (2006). Aggression and violence - a problem in Irish Accident and Emergency departments? Journal of Nursing Management, 14 (2), 106-15
Schnieden, V., & Marren-Bell, U. (1995). Violence in the accident and emergency department. Accident & Emergency Nursing, 3 (2), 74-8
Tang, J.S., Chen, C.L., Zhang, Z.R., & Wang, L. (2007) Incidence and related factors of violence in emergency departments--a study of nurses in southern Taiwan. Journal of the Formosan Medical Association, 106 (9), 748-58
The Joint Commission (2010). Preventing violence in the health care setting. Issue 45, June 3. Data accesso 16 Marzo, 2012. Da http://www.jointcommission.org /assets/1/18/SEA_45.PDF
United States Department of Labor, Occupational Safety and Health Administration (2012). Workplace Violence. Data accesso 17 Marzo, 2012. da http://www.osha.gov/SLTC/workplaceviolence/
Wilkes, L., Mohan, S., Luck, L., Jackson, D. (2010). Development of a violence tool in the emergency hospital setting. Nurse Researcher, 17 (4), 70-82
Winstanley, S., & Whittington, R. (2004). Aggression towards health care staff in a UK general hospital: variation among professions and departments. Journal of Clinical Nursing, 13 (1), 3-10
Zampieron, A., Galeazzo, M., Turra, S., & Buja A (2010). Perceived aggression towards nurses: study in two Italian health institutions. Journal of Clinical Nursing, 19 (15-16), 2329-41