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A critical or systematic review of research evidence on a topic of choice (topics may be selected /modified from a range of listed topics). Students will  identify an issue of controversy or interest from their current or past professional practice and then complete a critical review project. Students will be required to conduct a substantial independent research activity consisting of analysis of published data that does not require ethics committee approval.



Research indicates that workplace violence (also known as WPV) has steadily become routine in nations such as Australia, the United States (US), and a host of other nations, with special reference to the health care environment. Such assaults have been ranked as the third most common cause of deaths that arise from injury, as far as US workers are concerned. Keeping in mind all the different kinds of health care backgrounds, it has been discovered that the Emergency Departments (EDs) are particularly known to be high-risk situations for such violence. (Taylor and Rew 2011) This research analyses some current epidemiology and study pertaining to ED workplace violence inflicted by patients on nurses. It also considers ways in which it can be prevented; analyses real-world actions as well assets that Emergency Department providers, along with the concerned management can make use of in an attempt to minimise WPV, particularly in the case of ED; and pinpoints focus points for research in the future. It is also necessary to provide a list of recommendations to aid in the prevention of workplace violence in the Emergency Department. (Wolf et al. 2014).

The staff is faced with considerably heightened threats of physical attacks as contrasted with a range of diverse health care environments. Similar to various other kinds of violence, such as elder mistreatment, infant abuse, as well as domestic violence, workplace violence in the Emergency Department is an avoidable public health crisis that requires prompt and widespread attention. Emergency Department clinicians as well as the department’s management could then take the necessary steps to acquire hospital assurance to minimise such violence in the ED. They could also go on to acquire a work-siterelated analysis pertaining to the specific ED. (Talas et al. 2011) This would then require the usage of site-related violence deterrence mediations at the personal and organisational level, along with the need to back strategies and agendas that minimise the risk for Emergency Department WPV. Such attacks against Emergency Department health care staff is an actual problem with considerable consequences with respect to the targets and the specific department/organisation. Emergency Department workplace violence must be dealt with straightaway by shareholders with the help of sustained research pertaining to beneficial interventions relevant to Emergency Medication. Harmonisation, teamwork, and active support to the improvement of these involvements are vital. (Foureur et al. 2013).

What Does Workplace Violence Involve?

Work place violence could be defined as any condition in which an employee might be endangered, attacked or subject to abuse in a specific setting related to the employees work. This is inclusive of direct risk to the employee’s wellbeing, health as well as their mental health. It could also involve indirect threats to the employee’s wellbeing while in the workplace. (Gillespie et al. 2013)

Nursing, particularly pertaining to the Emergency Department, has been at the receiving end of exceptional attention for being a profession at great risk of violent assaults. As per statistics obtained from The National Crime Victimization Survey (in the years 1993-1999), it was discovered that the estimated annual rate pertaining to non-fatal violent attacks was 21.9 for every one thousand employees for nurses, contrasted with a far lower 12.6 for every thousand employees for diverse other professions. As per the Bureau of Labour Statistics, it was discovered that in the year 2004, forty six per cent of non-fatal assaults as well as violent deeds against medical practitioners, which also included days off work were carried out against RNs. The Emergency Department nurses are looked upon as being the most vulnerable targets of assaults while on duty. In a certain study, it was indicated that 82 per cent of the emergency department nurses stated that they were physically attacked at their workplace at certain points of time in the previous year. Additionally, it is also important to note that cases of verbal abuse are also on the rise, and it is this form of abuse which impacts one hundred per cent of emergency nurses in certain services.

It has also been discovered by The American Nurses Association that lower than 20 per cent of nurses graphed in 2001 experienced a feeling of safety in their existing work setting. Studies carried out have steadily discovered that nurses express their concern pertaining to fierceness and antagonism, insufficient safety procedures, as well as personal defencelessness in the Emergency Department. A number of nurses just lack a feeling of safety in their workplace. An apparent absence of institutional backing is a vital aspect in the disappointment that nurses experience. Such a feeling of organisational neglect might spring up from insufficient employment levels, exasperated assurances to increase environmental protection, disregarded anxieties, inadequate training and preparation, and absence of backing from colleagues, doctors, as well as overseers in the aftereffects of an event. Just and steady measures and principles of backing, instead of chastisement, for sufferers are vital. (Gates et al. 2011).

Aim of the Research

The purpose of this research is to carry out a critical review of the available literature to pinpoint factors that are contributing to workplace violence on nurses by patients, with reference to the Emergency Department, to enlighten and alter existing clinical practice so as to deal with this pressing concern. The outcomes of this review might be helpful in discovering areas for forthcoming research and variations in strategies pertaining to the wellbeing and safety of nursing staff in the Emergency Department. The advantage of this would be enhanced healthcare consequences for the ED nursing staff and reduced incidents of such atrocities in the healthcare system. 

This research considers whether strategies applied in the emergency department minimise/avert violence/assaults against nurses by patients. It also considers whether these strategies minimise the number of fiercely violent instances taking place in the Emergency Department, thus causing it to become a nonviolent work setting. The cases of violence and aggression will primarily be those that have been inflicted upon the nurses by patients and their family/carers. (Campbell et al. 2011)


For the purpose of this research, a systematic search of the available literature was carried out. This involved literature pertaining to the theme of assaults/antagonism concerning ED nurses. This information was utilised for this critical review. The specified search was carried out with the help of Cinahl, PubMed and Medline databases along with Google Scholar. Search terms used here involved “Aggression, violence, workplace violence, nurses and Emergency, “Strategies and interventions“. Such terms were then merged with the help of Boolean tools OR and AND. Also, the MeSH terms as well as the search words were merged to make sure that the required attention was paid to the detail of the search carried out. That spanned across a number of research papers in an attempt to make sure that numerous studies were incorporated to grasp the intricacies of the theme being spoken about in the study. Such a review would bring forth vital and beneficial information needed to carry out future research to precisely deal with the research question being asked here. (Campbell et al. 2011)

This specific search was carried out from the year 2011 to the year 2016 to make sure that the research reflects recent developments. The PICO structure was utilised to enhance literature search approaches. Search refinements will be inclusive of peer reviewed scholarly journals as well as relevant accessible articles. Additionally, full text articles were analysed to make sure that the linked content was able to provide a fitting answer to the research question. The abstracts of relevant articles will be analysed with reference to the research question. In the primary search conditions, every research design and systematic review was examined. The research studied was carried out on adult populations in Australia, Europe and various parts of America.

The exclusion criteria was on articles that were not majorly focussed on forms of violence or aggression affecting nurses in the Emergency Department. Research that has been carried out in other settings, part from the Emergency Department, have been left out so as to boost the possibilities of connecting results to the research question. The Evaluative tool pertaining to mixed method analyses was used as a tool to analyse quantitative as well as qualitative analyses necessary to carry out a critical review of the available literature. It will also make way for the evaluation of erratic control trials, blended methods analyses, qualitative analyses, descriptive research as well as quantitative studies that are descriptive in nature, so as to efficiently assess the quality as well as the significance of evidence. (Holden 2011).

The select set of mixed method analyses will be utilised to merge the advantages of not only qualitative but also quantitative research, along with reducing the extent of limitation pertaining to the research analysed. The violence or aggression related to nurses’ require the use of both kinds of methods in an attempt to comprehend novel experiences, along with measuring the degree of the concerns, inclusive of causes and effect, inclusive of strategies that are focussed on the reduction in the threat of aggression/assaults with reference to Emergency Department nurses: the use of existing methodologies. Finally, the utilisation of primary research will be beneficial in making sure that the bias is minimised and ideals such reliability and accuracy will be boosted. Existing research as well as theoretical models will reinforce the research question and aid in the identification of critically evaluating outcomes and approaches utilised.



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