Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses

Abstract

Background: Although efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence. Methods: A mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department. Results: Four key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of ‘toughness’) Conclusion: Emergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation