Violence Towards Nurses

Violence towards Nurses

Introduction

Emergence delirium in the postanaesthesia care unit (PACU) is poorly investigated. Such a delirium can suddenly become dangerous and have serious consequences for the patient such as injury, increased pain, haemorrhage, self-extubation and removal of catheters requiring physical or chemical restraint. The incidence of this type of delirium is around 3%, but has rarely been studied with the exception of paediatric anaesthesia. Furthermore, both the definition of emergence delirium and the phrasing (delirium, confusion, excitement, agitation) vary, as does its onset interval (upon awakening, within the first few hours, days or weeks). Another difficulty is the quantification of this agitation, as there is no specific scale.

What is Workplace Violence?

Emergence delirium is an everyday problem in the PACU. In our population, the incidence of delirium was overall 4.7%. In a review of literature, we found an average of 3%. Of all agitated patients in our study, more than 50% were graded very agitated or dangerously agitated (McNamara, 2010).

Different scales of agitation exist, such as the Riker agitation-sedation scale, the Richmond sedation-agitation scale, the motor activity assessment scale and the New Sheffield sedation scale. Studies have demonstrated that both the Riker and the Richmond scales have an excellent inter-rater reliability. The scales' advantages are their ease of use, especially in emergency situations, and their more precise evaluation of agitation compared with the Ramsay sedation scale, which rates essentially sedation. All of these scales were created for adults in intensive care. None has so far been established in the PACU. However, we feel that patients admitted to the PACU are comparable with patients admitted to the ICU.

The World Health Organization (WHO) defined violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation” (Punnett & Boyer, 2011). Workplace violence includes intimidation, verbal or physical threats, physical attack, property damage and sexual harassment. The major types of workplace violence are described in the table below.

Table 1 - Types of Violence

Type of Violence

Description

Verbal

Outbursts of yelling and screaming; use of an exaggerated or angry tone of voice; cursing; use of derogatory, foul, condescending, or inappropriate language, or use of racial or ethnic slurs. It is not always what is said but how it is said or when and where a comment is made.

Nonverbal

Includes eye rolling, raising eyebrows, making a face, turning away from a person, or physically excluding someone. Although these nonverbal behaviors are not spoken, they are seen and felt as abusive.

Passive behaviors

The absence of an action rather than an overtly identifiable action that directly affects communication between caregivers and can include not answering pages or returning phone calls, not responding to or being impatient with questions, deliberately communicating incomplete information, and silence.

Passive-Aggressive Behaviors

Behavior such as complaining about an individual to others; gossiping; badmouthing the organization, colleagues, or physicians to patients or others; discrediting leaders; fostering ...