A principal aim of epidemiology is to assess the cause of disease. However, since most epidemiological studies are by nature observational rather than experimental, a number of possible explanations for an observed association need to be considered before we can infer a cause-effect relationship exists.
Factors Influencing the Uptake of National Health Insurance Schemes among the...Premier Publishers
Purpose: Penetration of health insurance in the informal sector is very poor, this calls for upward scaling of successful interventions to remedy this situation given that health insurance increases access to healthcare services and improves financial risk protection. This study assessed the factors influencing uptake of national health insurance schemes among informal sector in Vihiga sub-county, Kenya.
Methods: Descriptive cross-sectional study design was used. The target population was the informal sector workers. A sample of 384 participants was selected by cluster and simple random sampling techniques. Data was collected using a semi-structured questionnaire. Descriptive statistics was summarized using tables, chi-square and bivariate logistic regression were used to test for associations (p<0.05).
Results: The study revealed that there was a significant influence of trust and knowledge of the health insurance scheme on the uptake of national health insurance (p < 0.05). The study further revealed that the attractiveness of the scheme had a big influence on the uptake of national health insurance
Conclusion: Trust and knowledge of the health insurance scheme had significant influence on uptake of national health insurance. Health Insurance Schemes should be designed in such a way that they attract informal sector workers and information regarding these schemes is disseminated to these people.
A principal aim of epidemiology is to assess the cause of disease. However, since most epidemiological studies are by nature observational rather than experimental, a number of possible explanations for an observed association need to be considered before we can infer a cause-effect relationship exists.
Factors Influencing the Uptake of National Health Insurance Schemes among the...Premier Publishers
Purpose: Penetration of health insurance in the informal sector is very poor, this calls for upward scaling of successful interventions to remedy this situation given that health insurance increases access to healthcare services and improves financial risk protection. This study assessed the factors influencing uptake of national health insurance schemes among informal sector in Vihiga sub-county, Kenya.
Methods: Descriptive cross-sectional study design was used. The target population was the informal sector workers. A sample of 384 participants was selected by cluster and simple random sampling techniques. Data was collected using a semi-structured questionnaire. Descriptive statistics was summarized using tables, chi-square and bivariate logistic regression were used to test for associations (p<0.05).
Results: The study revealed that there was a significant influence of trust and knowledge of the health insurance scheme on the uptake of national health insurance (p < 0.05). The study further revealed that the attractiveness of the scheme had a big influence on the uptake of national health insurance
Conclusion: Trust and knowledge of the health insurance scheme had significant influence on uptake of national health insurance. Health Insurance Schemes should be designed in such a way that they attract informal sector workers and information regarding these schemes is disseminated to these people.
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Social integration and the mental health needs of lgbtq asylum seekers in nor...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
Researchers call for a unified approach to preventing suicides and other self...Mrsunny4
Self-injury mortality (SIM), a composite of all methods of suicide and estimated non-suicide deaths from drug self-intoxication, has surpassed diabetes as the seventh leading cause of death in the United States, prompting researchers to call for a new unified approach to SIM prevention.
At the end of this session, the students shall be able to, Define Cause
Define Association
Define Correlation
Types of association
Additional criteria for judging causality
Differentiate between association and causation
Vikas Joshi doctoral research synopsis: 'The Coevolution of Technology Firms ...Dr. Vikas Joshi
Vikas Joshi Presentation to Pune Entrepreneurs based on his Doctoral Research: 'The Coevolution of Technology Firms and Founders' at Ambrosia, Pune 2016
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Social integration and the mental health needs of lgbtq asylum seekers in nor...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
Researchers call for a unified approach to preventing suicides and other self...Mrsunny4
Self-injury mortality (SIM), a composite of all methods of suicide and estimated non-suicide deaths from drug self-intoxication, has surpassed diabetes as the seventh leading cause of death in the United States, prompting researchers to call for a new unified approach to SIM prevention.
At the end of this session, the students shall be able to, Define Cause
Define Association
Define Correlation
Types of association
Additional criteria for judging causality
Differentiate between association and causation
Vikas Joshi doctoral research synopsis: 'The Coevolution of Technology Firms ...Dr. Vikas Joshi
Vikas Joshi Presentation to Pune Entrepreneurs based on his Doctoral Research: 'The Coevolution of Technology Firms and Founders' at Ambrosia, Pune 2016
Prof. Mridul M. Panditrao, from his University/ medical College days, gives tips on how to write your synopsis for your dissertation after you have registered and started your MD/ MS training programme. he also gives ideas/ steps to come up with a well constructed synopsis. Very useful for the first year MD/ MS PG students
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
Serieswww.thelancet.com Vol 379 June 23, 2012 2373.docxlesleyryder69361
Series
www.thelancet.com Vol 379 June 23, 2012 2373
Lancet 2012; 379: 2373–82
See Editorial page 2314
See Comment page 2316
See Perspectives page 2333
This is the fi rst in a Series
of three papers about suicide
Centre for Suicide Research,
University Department of
Psychiatry, University of
Oxford, Oxford, UK
(Prof K Hawton DSc,
K E A Saunders MRCPsych); and
Suicidal Behaviour Research
Group, School of Natural
Sciences, Stirling University,
Stirling, Scotland
(Prof R C O’Connor PhD)
Correspondence to:
Prof Keith Hawton, Centre for
Suicide Research, University
Department of Psychiatry,
Warneford Hospital,
Oxford OX3 7JX, UK
[email protected]
Suicide 1
Self-harm and suicide in adolescents
Keith Hawton, Kate E A Saunders, Rory C O’Connor
Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage
years and suicide being the second most common cause of death in young people worldwide. Important contributors to
self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors.
The eff ects of media and contagion are also important, with the internet having an important contemporary role.
Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted
initiatives focused on high-risk groups. There is little evidence of eff ectiveness of either psychosocial or pharmacological
treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for
suicide is important. Major challenges include the development of greater understanding of the factors that contribute
to self-harm and suicide in young people, especially mechanisms underlying contagion and the eff ect of new media.
The identifi cation of successful prevention initiatives aimed at young people and those at especially high risk, and the
establishment of eff ective treatments for those who self-harm, are paramount needs.
Introduction
Adolescent self-harm is a major public health concern.
Although suicide is uncommon in adolescents compared
with non-fatal self-harm, it is always a tragic outcome, and
prevention of suicide in young people is under standably a
focus of national strategies for suicide prevention. In this
paper, we discuss self-harm and suicide in adolescents in
terms of epidemiology (especially international diff er-
ences); developmental aspects of self-harm, including
short-term and long-term outcomes; factors that contribute
to the behaviour; and treatment and prevention. This is a
selective paper directed at any professional with an interest
in adolescent suicide and self-harm. We have two aims: to
provide a synthesis of the evidence for adolescent self-
harm and suicide and to identify key areas of uncertainty.
Only a small proportion of individuals who self-harm
present to hospitals, meaning that this behaviou.
A 5-Year Retrospective Analysis of Legal Intervention Injuries and Mortality ...Jim Bloyd, DrPH, MPH
There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement-related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.
Narrative review: Is it rational to pursue Zero Suicides among patients in he...Jan Mokkenstorm
Suicide prevention is a major health care responsibility in need of new perspectives. This study reviews Zero Suicide, an emerging approach to suicide prevention that embraces the aspirational goal of zero suicides among patients treated in health care systems or organizations. Zero Suicide is gaining international
momentum while at the same time evoking objections and concerns. Fundamental to Zero Suicide is a multilevel system view on suicide prevention, with three core elements: a direct approach to suicidal behaviors; continual improvement of the quality and safety of care processes; and an organizational commitment to the aspirational goal of zero suicides. The rationale and evidence
for these components are clarified and discussed against the backdrop of concerns and objections that focus on possible undesired consequences of the pursuit of zero suicide, in particular for clinicians and for those who are bereaved by suicide. It is concluded that it is rational to pursue zero suicides as
an aspirational goal, provided the journey toward zero suicides is undertaken in a systemic and sustained manner, in a way that professionals feel supported, empowered, and protected against blame and inappropriate guilt.
Using Everett Rogers' Diffusion of Innovations Theory an intervention for automatic STI screening for adolescents is applied to primary care settings in Baltimore, Maryland.
Perceptions of tertiary students on the prevention of sexually transmitted di...iosrjce
The purpose of the study was to evaluate tertiary student’s sexual behaviour and their knowledge and attitudes
towards STDs, among students of University for Development Studies (UDS).
The research design: data was collected by using a quantitative survey using self-answered questionnaire, from
a sample of one hundred and thirty-four (n=134) out of a total student population of 3,881, using the simple
random sampling technique in the data gathering process.
Results/findings: out of the sample size of 134 students aged 15-44, 46.3% were males and 53.7% were females.
About 24.6%, (n=33) have ever had sex without a condom. The study revealed that 99.3% ever heard of STDs,
85.1% had either below or average knowledge about the causes of STDs, 55.2% had knowledge above average
on the prevention of STDs and more than 90% of the student sampled indicated that STDs are very common.
Interestingly, 6.7% of the sampled population said STDs are mainly female infections.
Recommendations: There is need for wider education at various levels of the educational system on STDs by
health care providers, and effective collaboration among health care providers, social activists, NGOs and
tertiary students to promote peer education on STDs prevention among students.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdf
Violence in the Emergency Department - 2
1. Running head: VIOLENCE IN EMERGENCY DEPARTMENTS 1
Violence in Emergency Departments
Edward Struzinski, RN
Kaplan University
2. VIOLENCE IN EMERGENCY DEPARTMENTS 2
Violence in Emergency Departments
There is an important issue in healthcare that is significantly trending, especially within
the emergency department. Violent situations and eruptions have steadily increased, an issue that
is not isolated to within the borders of the United States but is reported and being studied on an
international scale. Violence and aggression is everywhere: hospitals are no exception. They are
organizations that actively seek and need the human factor to generate income and maintain their
status as a business. Emergency departments are essentially open for business twenty-four hours
a day. They are an obvious area of high emotions during medical crises, a source of various
pharmaceuticals with strong potential for abuse, and even an undetermined amount of money
held by registration clerks. Several hospitals are located within poor or dangerous sections of
inner cities and the emergency departments cannot choose their clientele visiting them. This
leaves the door wide open to unpredictable people that may also lead to unpredictable situations,
including physical injury or death. Nurses and staff in the emergency department, among other
areas, are at a much greater risk of experiencing violence and aggression from patients or their
visitors than other departments in the hospital (Gillam, 2014). This is the second essay in a series
of three articles that aims to discuss a compilation of current literature on the subject of violence
found in the emergency department, identifying common themes, factors, pitfalls, and report on
statistical analysis of this very important issue that has numerous consequences.
A review of literature
A review of several sources was carefully evaluated for validity in reporting. All articles
on the subject were peer-reviewed. They included research projects utilizing questionnaires,
taped interviews, incident reports, surveys, and several review articles. After careful review of
various literature and other sources on the subject of emergency room violence, several themes
3. VIOLENCE IN EMERGENCY DEPARTMENTS 3
were identified that trended together. They include: incidence or prevalence of violent events
specifically in the emergency department, under-reporting by staff, desensitization of staff in the
face of violence, lack of appropriate training in dealing with aggressive behavior or violent
individuals of whom many are under the influence of alcohol/ drugs or whom have a mental
health history, and lack of support from administrative leadership. The last common link
detailing administrative response is actually quite interesting to learn in light of the events that
occur and the very likelihood of subsequent injuries, property damage, and financial
reimbursements associated with it – to say nothing about the negative effects on department
morale that itself has an affect on the business.
Overall, the incidence of aggressive events and violent outbursts occurring in emergency
departments is staggering. Although it is slightly outdated information, in 1992, the nursing
profession logged the highest number of physical attacks in the workplace (Pich, Hazelton,
Sundin, & Kable, 2010). However, with recent reports showing violence to have only trended
upward in the healthcare industry since and much of it going unreported, this data from
essentially only twenty years ago could still be on target. Most aggressive actions are aimed at
nursing staff and registered nurses generally take the impact of all these aggressive or violent
outbursts. Although there is no solid definition for nursing violence in the emergency rooms,
much of the literature defines the actions as verbal or physical in nature. Physically violent
incidents have a wide range of actions that include being hit, kicked, pushed, spit on, bitten, or
any aggressive action made with the general aim to harm the target. Verbally abusive incidents
can be defined as those with non-contact. These can include threats, gestures, yelling or any non-
physical attempts to frighten or intimidate the subject. They almost entirely will always include
abusive language, swearing, or racial and ethnic epithets.
4. VIOLENCE IN EMERGENCY DEPARTMENTS 4
Through their nine-month study involving six hospitals, researchers Kowalenko, Gates,
Gillespie, Succop, and Mentzel (2013) found the emergency departments to have the highest risk
of violence and nursing staff to have an assault-injury rate that was ten times higher when
compared to other areas. Also reported by Kowalenko et al. (2013), statistical analysis from the
Bureau of Labor Statistics revealed nearly sixteen percent of all physical altercations across all
industries occurred to those in the nursing staff and assistants. Another study conducted by
researchers over a one-year period affirmed physical violence on seventy-two percent of subjects
over the course of their career, over forty percent in the year preceding the study, and almost
sixty percent assaulted in yet another study that also spanned a one-year period (Taylor & Rew,
2011). A smaller study of emergency room nurses from six institutions in Nigeria showed not
only a ninety percent response rate to the surveys but that almost ninety percent of the
respondents bore witness to violent or aggressive acts in their emergency departments (Ogundipe
et al., 2013).
Finally, ninety-eight percent of another study – almost the entire body of research
subjects – reported verbal aggression or abuse in the emergency department (Pinar & Ucmak,
2011). From these accounts, one can easily see that violence in the emergency department is a
significant problem that is felt globally. It has the highest incidence of violence in healthcare and
is increasing. And although that sounds alarming, one must not forget that these figures are only
generated by the information that is actually reported. To that end, there are likely three or four
times the number of cases that go unreported.
Under-reporting of incidents and desensitization
Another common link to the literature review is the discussion by researchers on the
under-reporting of violent encounters or other aggressive events in the emergency department
5. VIOLENCE IN EMERGENCY DEPARTMENTS 5
that should have been brought to the attention of managers, etc., but were not for a variety of
reasons. One reason commonly shared across the literature is the idea that violence and other
volatile situations is an expected part of the job in dealing with the public or treating patients in
the emergency department. That perception alone by healthcare workers minimizes the
significance for reporting events, and because of it, there is desensitization to the issue.
Pich et al. (2010) reports on many nurses rationalizing violent behavior as an unavoidable hazard
that is expected to come with the occupation. Additionally, Powley (2013) reports many nurses
rationalize not reporting incidents based on the idea that it was not the true intention of many
patients to lash out at them. Considering these factor, the true incidence of emergency
department violence to date remains unknown; estimations could range anywhere from as little
as twenty percent to as shocking as ninety percent (Pich et al., 2010). Kowalenko et al. (2013)
determined under-reporting in their cases and other studies to be a common theme. In fact, only
half of the incidents were brought to the attention of hospital administration and an astounding
five percent of physical assaults were reported to law enforcement (Kowalenko et al., 2013).
That translates to mean that ninety-five percent of assaults on healthcare workers from patients
and visitors were not reported to the police to be brought up on charges of battery in that
particular study by researchers.
In their investigation on the subject, Taylor and Rew (2011) state how under-reporting of
events was a consistent parameter across the studies and literature they collected. This is
habitually true with all forms of aggression, be it verbal or physical. Both of which can
negatively impact the individuals it is aimed at, the morale of the department, and ultimately
patient care. The victims often dismissed incidents of violence in the emergency department of
another study that still had negative impacts on department morale (Belayachi, Berrechid,
6. VIOLENCE IN EMERGENCY DEPARTMENTS 6
Amlaiky, Zekraoui, & Abouqal, 2010). Many nurses will often feel a moral dilemma between
reporting violent occurrences with those they are caring for, feeling that is something that comes
along with the job (Powley, 2013). However, moral dilemma or not, the incidence of not
reporting these particular events is as high as the incidents themselves and just as significant.
Importance of proper training
By far, several literature studies and sources uncovered a significant issue on the safety of
employees in the emergency department regarding how to approach a tense situation or
otherwise unruly patient with the intent for de-escalation versus physically restraining the
subject. In the study by Ogundipe et al. (2013), all six hospitals within the research project had
poor prevention plans and lacked in basic safety strategies. These included a range of topics from
on-site security or other surveillance to proper training of staff in crisis management. Three-
quarters of the research subjects in the project reported they had no form of skilled training in
managing or even identifying an erupting or violent situation (Ogundipe et al., 2013).
De-escalation training is a helpful solution to preventing impending violence. It requires
training using an empathetic and psychological approach to reducing a tense or evolving
situation. By first recognizing and identifying impending crises early along with using
negotiation skills for conflict resolution, the idea of de-escalation techniques is to prevent a
situation from worsening (Touzet et al., 2014). This is the idea behind the STAMP method of
identification shared in the various literature sources. STAMP is an acronym professionals can
use to recognize aggression that is brewing before it reaches the boiling point. Angry or upset
people in emergency rooms will often display signs of staring, tone of voice, anxiety, mumbling,
and pacing (Pich et al., 2010; Taylor & Rew, 2011). This acronym allows nurses and other staff
to recognize signs early and take appropriate, corrective action, including calling for hospital
7. VIOLENCE IN EMERGENCY DEPARTMENTS 7
security or even the police. Although despite all the literature showing nursing staff generally
receives little or no training in dealing with violence matters, some nursing staff choose not to
call for help, feeling they can still resolve the flaming situation on their own (Gillespie, Gates,
Miller, & Howard, 2012). This appears to be a show of poor judgment in the face of danger.
Generally speaking, unless a hospital formally provides training in nursing orientation for
dealing with behavioral subjects, it seems to be a skill that is learned on the job and through trial
and error of experiences. Errors can have grave consequences. One study reported sixty-nine
deaths to nursing staff that occurred in a matter of four years time (Pich et al., 2010). That is an
average of between one and two deaths to healthcare workers that happened every month! Proper
training cannot be over-emphasized. Pinar and Ucmak (2011) reiterates that the Occupational
Health and Safety Act mandates employers adequately train their employees so as to work safely
and minimizes risks to their well-being. In spite of this, upwards of eighty-five percent of nurses
reported receiving no such training during their orientation, yet they thought or felt they should
have (Pinar & Ucmak, 2011) in order to be better prepared to manage angry or upset individuals
that one is likely to encounter often in an unpredictable environment like emergency rooms.
Emergency departments offer very little for environmental factors that heighten the risk
of violence to occur, especially with psychiatric patients that should have a quieter atmosphere. It
has been suggested there is a connection with severe mental illness and violent behavior, tripling
the odds of a potential outburst for those who suffer from such diseases like schizophrenia or
bipolar disorder (Pich et al., 2010). In fact, mental illness and alcohol intoxication were shared
across much of the literature as factors influencing violence and aggression. Intoxicated
individuals generally have a lower threshold for having patience and they are significantly
correlated to violence in some fashion with risk statistics for violence ranging from twenty-five
8. VIOLENCE IN EMERGENCY DEPARTMENTS 8
percent to ninety-eight percent (Pich et al., 2010); there was also a demonstrated increase in
violent episodes in the emergency department that coincided with the number of patients with
mental illness (Gillam, 2014) in the department.
Administrative response influences
Sources also included how respondents felt that administrative leadership was a negative
influence on their decision to either report or not report incidents of violence. There was
generally a lack of support reported surrounding those from whom the employees would look to
for support and direction. Nurses reported feeling a lack of support from managers, fear of
retaliation, or were just not happy with feedback received (Pich et al., 2010). According to
Ogundipe et al. (2013) the health industry as a whole does not have now or even applied a zero-
tolerance policy toward violence occurring in the workplace, sharply contrasting other
businesses. It has been suggested zero-tolerance policies have been viewed by some
administrators as being unreasonable in healthcare because it interferes with establishing a
satisfying relationship with patients (Pich et al., 2010) – customers of a business.
Conclusion
Healthcare violence is not a new subject. Some of the surveys performed in the literature
review could be called into question for their validity, mostly due to respondent bias on the
subject of being the target of a violent or aggressive act. Kowalenko et al. (2013) suggest several
workers may also have opted out of research projects due to not wanting to relive an experience.
The literature reviewed, however, showed interesting trends in data and information, particularly
the frequency of violent and aggressive occurrences to nursing staff in the emergency
departments on an international scale. In particular, those working in the specialty consider the
violent actions inflicted by mostly patients or visitors as a normal part of the working day.
9. VIOLENCE IN EMERGENCY DEPARTMENTS 9
Because of the predominance of these acts, there is desensitization to the issue of verbal and
physical assaults on healthcare workers. This has led to an occupational acceptance of unsafe
behaviors that are certainly also disrespecting to educated professionals whom have pledged to
care for others. Multiple events go undocumented and unreported to administrators and other
authorities because of this generalized acceptance, of which the true results would likely be too
alarming to believe as possible. Lack of appropriate training and feelings of an unsupportive
management only complicate matters that require formal and responsible actions. This can be
identified as a problem rather than a solution. Solutions to the violence happening to healthcare
workers in the emergency department, if there are any, is largely preventative and requires
unanimous cooperation and support in finding a resolute answer. This must come from all who
are involved, including the perpetrators, as responsibility includes accountability.
10. VIOLENCE IN EMERGENCY DEPARTMENTS 10
References
Belayachi, J., Berrechid, K., Amlaiky, F., Zekraoui, A., & Abouqal, R. (2010). Violence toward
physicians in emergency departments of Morocco: Prevalence, predictive factors, and
psychological impact. Journal of Occupational Medicine & Toxicology, 527-33.
doi:10.1186/1745-6673-5-27
Gillespie, G., Gates, D. M., Miller, M., & Howard, P. (2012). Emergency department workers'
perceptions of security officers' effectiveness during violent events. Work, 42(1), 21.
Gillam, S. (2014). Nonviolent crisis intervention training and the incidence of violent events
in a large hospital emergency department: An observational quality improvement study.
Advanced Emergency Nursing Journal, 36(2), 177-188.
doi:10.1097/TME.00000000000000
Kowalenko, T., Gates, D., Gillespie, G., Succop, P., & Mentzel, T. (2013). Prospective study of
violence against ED workers. The American Journal of Emergency Medicine, 31(1),
197-205. doi:10.1016/j.ajem.2012.07.010
Ogundipe, K., Etonyeaku, A., Adigun, I., Ojo, E., Aladesanmi, T., Taiwo, J., & Obimakinde, O.
(2013). Violence in the emergency department: A multicentre [sic] survey of nurses'
perceptions in Nigeria. Emergency Medicine Journal: EMJ, 30(9), 758-762.
doi:10.1136/emermed-2012-201541
Pich, J., Hazelton, M., Sundin, D., & Kable, A. (2010). Patient-related violence against
emergency department nurses. Nursing & Health Sciences, 12(2), 268-274.
doi:10.1111/j.1442-2018.2010.00525.x
11. VIOLENCE IN EMERGENCY DEPARTMENTS 11
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), 510-517.
doi:10.1111/j.1365-2702.2010.03520.x
Powley, D. (2013). Reducing violence and aggression in the emergency department.
Emergency Nurse, 21(4), 26-29.
Taylor, J., & Rew, L. (2011). A systematic review of the literature: Workplace violence in the
emergency department. Journal of Clinical Nursing, 20(7/8), 1072-1085.
doi:10.1111/j.1365-2702.2010.03342.x
Touzet, S., Cornut, P., Fassier, J., Le Pogam, M., Burillon, C., & Duclos, A. (2014). Impact of a
program to prevent incivility towards and assault of healthcare staff in an
ophtalmological [sic] emergency unit: Study protocol for the PREVURGO On/Off trial.
BMC Health Services Research, 14(1), 40-56. doi:10.1186/1472-6963-14-221