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Patient violence remains a risk for RNs

Friday August 22, 2014
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Nurses are at a higher risk of being harmed by patient violence, according to a study published online Aug. 4 by the Journal of Advanced Nursing.

The study examined 214 incidents of violence by patients against healthcare workers in 2011 at a Midwest health system composed of seven hospitals. The majority of incidents, almost 40%, were reported by nurses. Cognitive impairment and demanding to leave were among the behaviors that contributed to the violence, according to the study. Other causes included the use of needles, patient pain and discomfort and physical patient transfers. Use or presence of restraints, transitions in the care process, intervening to protect patients and staff, and redirecting or helping patients back to their rooms or beds also were factors.

About 16% of violent incidents were reported by security staff. Nurse assistants reported about 14% of incidents.

“Identifying catalysts and situations involved in patient violence in hospitals informs administrators about potential targets for intervention,” the study’s researchers concluded. “Hospital staff can be trained to recognize these specific risk factors for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behavior. A social–ecological model can be adapted to the hospital setting as a framework for prevention of patient violence towards staff.”

When it came to patient care, the use of any type of needle, such as during lab work or IV insertion was a common cause of physical violence, the study said. But violence also occurred during procedures such as hooking up feeding tubes, intubating patients or positioning the patients for X-rays or other types of scans.

“Systematic review of incident reports provides a wealth of information regarding catalysts to and circumstances surrounding patient violence towards nurses and other hospital workers,” Judith Arnetz, PhD, MPH, PT, lead author of the Journal of Advanced Nursing study, said. “Hospital staff can be trained to recognize these specific risk situations for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behavior.”

According to the Emergency Nurses Association, more than 50% of ED nurses experienced violence from patients in 2009. Of the 2,050 assaults and violent acts reported by RNs requiring about four days away from work that year, 1,830 were caused by patients or residents. The Bureau of Labor Statistics reported in 2011 that eight RNs were killed at work between 2003 and 2009.

In January, Illinois joined more than 20 states that have made any degree of assault or battery on an emergency nurse a felony, according to the ENA. Under the state’s law, battery against nurses is a Class 3 felony, punishable with a two-to-five year prison sentence, a news release from the association stated. In Louisiana, Gov. Bobby Jindal signed a bill in June making it a felony to physically attack an emergency nurse.

To read the full study in the Journal of Advanced Nursing, visit http://onlinelibrary.wiley.com/doi/10.1111/jan.12494/full.


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