The American Association of Critical-Care Nurses publishes AACN Advanced Critical Care. Stanford University Libraries' HighWire Press® assists in the publication of ACC Online.

Current Issue : July-September 2016

From the Editor

It seems we are faced with increasing violence every day. The hospital setting is no exception in terms of the potential for nurses to encounter violence from the patients and families for whom they care or from colleagues. Healthcare providers are in a unique position for the potential of violence because of intimate interactions with patients and families at times of high stress, frustration, and life-altering and devastating situations. What constitutes violence? Definitions vary, but in general violence experienced by nurses includes verbal abuse, threats, harassment, and physical assault.1 These interactions can result not only in physical but psychological harm.

In the acute care setting, reasons for violence vary: diagnosed or undiagnosed mental illness or physical derangements such as hypoxia, electrolyte imbalances, substance withdrawal, or medication reactions that can lead to fear, confusion, delirium, and paranoia in our patients. Although some tools to assess the potential for violence have been developed for use in the behavioral health setting, research for assessing the potential for violence in patients in acute care is lacking. Regardless, it is unlikely that any tool will be able to accurately predict the potential for violence 100% of the time in patients. So what can you do to optimize your ability to deal with patients who exhibit violent behaviors?

  • Partner with mental health caregivers in your setting to start the dialogue about potential areas of vulnerability and ways to avoid escalation of situations.
  • Partner with security personnel for consistency in approaches and rapid response as situations escalate.
  • Assess your physical environment to evaluate for improvements that can keep healthcare providers safe.
  • Consider actions that should be routine with patient care to avoid getting caught in violent situations.
  • Learn de-escalation techniques, which can be helpful both at work and in life.

Nurses must have the tools and skills to prevent violent behavior if possible, plus the ability to de-escalate situations that become contentious. These types of situations will not go away. By proactively examining our environments and resources, we are more likely to be prepared with an action plan rather than being caught off guard.

Mary Fran Tracy, RN, PhD, CCNS

1.  Gacki-Smith J, Juarez AM, Boyett L, Homeyer C, Robinson L, MacLean SL. Violence against nurses working in US emergency departments. J Nurs Admin. 2009;39(7/8):340-349.

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