Violence towards Emergency Nurses. The Italian National Survey 2016: A qualitative study

https://doi.org/10.1016/j.ijnurstu.2018.01.017Get rights and content

Abstract

Introduction

Physical and verbal aggression against health professionals, particularly nurses, is globally serious and widespread, with the most vulnerable being nurses working in the Accident and Emergency Department. Most international research into this issue focused on quantifying aggression, describing its nature, identifying perpetrators, stratifying risk and implementing preventive or mitigating interventions. Few studies investigated the nurses’ subjective perceptions. As part of the 2016 Italian National Survey on Violence against Accident and Emergency Nurses, our research team collected qualitative data to explore their perceptions of Workplace Violence.

Methods

From 19th July 2016 to 19th March 2017 we distributed online a 39-item validated questionnaire to 15,618 Emergency Nurses working in 668 Italian National Health Service Accident and Emergency Departments in all 20 Italian Regions. Answers were analysed using van Kaan’s method.

Results

1100 Emergency Nurses responded to the survey and 265 replied to our focus question. There were 144 Females, 119 Males, 2 not stated, average age 42 ± 9 years, average work experience 18 ± 9 years, average Accident and Emergency Department experience 11 ± 8 years. Four major themes emerged: the nurses’ perception of physical and verbal aggression, precipitating factors, consequences, and solutions.

Discussion

These themes confirmed previous findings and showed that Italian nursing staff’s perceptions of physical and verbal aggression is the same as emergency nurses working worldwide.

Conclusion

How Italian Accident and Emergency nurses perceive Workplace Violence adds to our knowledge of the issue and contributes to finding shared solutions.

Section snippets

What is already known about the topic?

  • •

    Violence against Emergency Nurses is a worldwide problem.

  • •

    Although many studies addressed the issue, in-depth research is still needed.

  • •

    Few studies investigated the nurses’ subjective perceptions.

What this paper adds

  • •

    Italian Accident and Emergency nurses feel left alone in face of violence, which is considered an intrinsic part of the job.

  • •

    Being aware of their subjective perceptions can help develop support and effective strategies to combat workplace violence.

  • •

    Developing strong co-operation among all stakeholders (nurses, hospital managers, security service, police, mass media, etc) is essential to counteract physical and verbal aggression in the workplace.

Definitions

Since several definitions of client-on-worker violence exist i.e. Type II Violence, according to the University of Iowa Injury Prevention Research Center (UIIPRC, 2001), our research group opted for the National Institute of Occupational Safety and Health (NIOSH) definition: “[…] violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty” (National Institute of Occupational Safety and Health, 2002).

Data collection

Data were collected between 19th July 2016 and

Results

Twenty-seven minor themes emerged, which were grouped into four major themes: the nurses’ perception of physical and verbal aggression, precipitating factors, consequences, and solutions. All were analysed in the conceptual model underlying the study (Fig. 1).

Table 2 shows 4 major and 27 minor themes as well as sentence keywords that emerged from qualitative analysis of replies.

Discussion

The open question at the end of the 2016 Italian National Survey was designed to enable responders to develop some of the answers they had already given to other questions in the survey. Actually only three participants used the space in this way. Responders could supply their own views on the issue of workplace violence, which was the object of our analysis. Alternatively they could simply vent their feelings, which not many did. Finally, only three nurses claimed they deserved some kind of

Conclusions

Limitations of the present study are linked to features of Italian culture and healthcare organization. The Italian National Health Service provides free point of care treatment to all patients, with minimal charges being applied only for non-urgent codes. Even though results from Italy, a southern European country with a Western, Mediterranean culture, may not appear to be applicable elsewhere, we are convinced they can be translated into other healthcare settings and cultural backgrounds. In

Conflicts of interest

None declared.

Acknowledgements

The Authors thank the Italian Critical Care Nurses Association – Aniarti and the online journal Nurse24 for publishing the survey on their social media channel, and all nursing colleagues who participated in the survey.

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