<p>Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base</p>

Abstract

IntroductionAggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same.AimTo identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient.MethodsA meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice.ResultsAn initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested.Clinical ImplicationsThe lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice.ConclusionThere is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified.

Workplace Aggression and Burnout in Nursing—The Moderating Role of Follow-Up Counseling

“…Generally, knowledge of how organizations can reduce the negative impact of exposure to workplace aggression and violence on nurses' mental health is very limited [21,22]. This study adds to the few studies on post-event intervention strategies in healthcare settings [24,25] and advances the understanding of how organizations may mitigate the damages associated with workplace aggression and violence in nursing.…”

“…Post-event interventions (e.g., debriefing, counseling) are widely considered an effective strategy for minimizing potentially negative psychological consequences of exposure to aggression and violence [21][22][23]. While post-event interventions may take various forms, the general idea of such offers is to assist employees in coping with the stress arising from experiences of workplace aggression through the provision of social support [24].…”

“…While post-event interventions may take various forms, the general idea of such offers is to assist employees in coping with the stress arising from experiences of workplace aggression through the provision of social support [24]. However, empirical evidence on the effectiveness of post-event interventions for managing aggression and violence in terms of healthcare workers' mental health is very limited [21,22]. In one of the few studies on post-event interventions in healthcare settings, informal counseling and debriefing sessions after experiences of violence were found to improve healthcare workers' reporting of violent incidents, awareness of risks for violence, avoidance of violent situations, and violence management skills [25].…”

Management approach of patients with violent and aggressive behaviour in a district hospital setting in South Africa

“…The Haddon matrix ( Table 3 1 ) has been widely used in conceptualising injury prevention threats and modelling solutions. 1 It consists of three different phases of an injury (pre-event, event and post-event) and the influencing factors (host, agent/vehicle physical environment, social environment factors). Host factors relate to the person or persons at risk of injury (doctors, nurses, hospital personnel and community members).…”

“…However, there are limited evidence-based intervention strategies to guide the management of patients with aggressive and violent behaviour in acute hospital settings. 1 Violence and aggression comprise a wide range of behaviours or actions, which can potentially cause harm, hurt or injury by someone to another person. 2 Violent and aggressive patients have the intention to dominate another person; as such, they express anger, defensive behaviour, verbal abuse, derogatory remarks, threats or non-verbal gestures.…”