EFFECTIVE INTERVENTIONS FOR REDUCING VIOLENCE AGAINST EMERGENCY NURSES: A SYSTEMATIC REVIEW

Yousefi, Hadi; Asadinoghabi, Fariba; Salari, Saeed

Volume 22, Issue 10 (January 2025) Nursing and Midwifery Journal 2025, 22(10): 811-827 | Back to browse issues page

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Yousefi H, Asadinoghabi F, Salari S. EFFECTIVE INTERVENTIONS FOR REDUCING VIOLENCE AGAINST EMERGENCY NURSES: A SYSTEMATIC REVIEW. Nursing and Midwifery Journal 2025; 22 (10) :811-827
URL: http://unmf.umsu.ac.ir/article-1-5273-en.html

EFFECTIVE INTERVENTIONS FOR REDUCING VIOLENCE AGAINST EMERGENCY NURSES: A SYSTEMATIC REVIEW

Hadi Yousefi¹

, Fariba Asadinoghabi²

, Saeed Salari ^*

1- Associate Professor of Epidemiology, School of Nursing and Midwifery, Bandar Abbas University of Medical Sciences, Hormozgan, Iran
2- Ph.D, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3- M.Sc. Nursing Student, School of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran , saeed.salari128@gmail.com

Abstract: (43 Views)

Background & Aim: Workplace violence, particularly in emergency departments, is a global issue and a significant public health priority. Nursing, especially in emergency settings, is one of the professions with the highest reported rates of violence. This violence has serious impacts on the mental health and work quality of nurses, making effective interventions to reduce it essential. The aim of this study was to identify and evaluate various interventions to reduce violence against nurses and improve their working conditions.
Materials & Methods: This study was conducted by searching databases including Google Scholar, Magiran, Scientific Information Database (SID), Web of Science, Scopus, and PubMed using keywords such as "violence", "nurses", "emergency department", and "intervention methods" between 2014 and 2024. Out of 4,075 identified articles, after removing duplicates (1,043 articles) and irrelevant studies (3,193 articles), abstracts were screened. Ultimately, 116 articles were selected for eligibility assessment, and 19 articles were included in the study. The quality of evidence was evaluated using the GRADE checklist (Grading of Recommendations, Assessment, Development, and Evaluations). This checklist was used to assess randomization, risk of bias, and generalizability of results. Articles were selected based on criteria such as being interventional, having full-text availability, focusing on violence against nurses in emergency departments, and being in Persian or English. Articles without full-text access or those that were conference papers or letters to the editor were excluded from the review process.
Results: In the 19 reviewed studies, all participants were nurses working in emergency departments. The studies were designed as experimental, quasi-experimental, and two studies used a mixed-methods approach combining quasi-experimental and qualitative methods. Interventions included in-person and online training, managerial and environmental changes, anger and behavior management, risk assessment protocols, preventive protocols, communication skills, triage algorithms, and simulations.
Conclusion: Training in communication skills and anger management, along with improving the work environment, can significantly reduce violence against emergency nurses. Continuous training programs and managerial changes such as risk assessment and improving working conditions can be effective in preventing violence. Additionally, establishing supportive policies and cultures to encourage reporting of violent incidents is of great importance. Through comprehensive programs and innovative technologies, safer conditions can be provided for nurses.

Keywords: Emergency Department, Intervention Methods, Nurses, Violence

Full-Text [PDF 672 kb] (47 Downloads)

Type of Study: Review article | Subject: پرستاری

References

1. MohammadiGorji S, Bosch SJ, Valipoor S, De Portu G. Investigating the impact of healthcare environmental design on staff security: a systematic review. Health Env Res Design J 2021;14(1):251-72. [PMID: 32943297] [DOI:10.1177/1937586720921407]

2. LeBlanc MM. Predictors and outcomes of workplace violence. University of Guelph; 2000. [URL:]

3. Rahmani A, Roshangar F, Dadashzadeh A, Namdar H, Akbari M, Nabiolahi L. Verbal violence against the paramedics working in Tabriz University of Medical Sciences and related cities. J Tabriz Univ 2010;14(2):33-9. [URL:]

4. Al-Qadi MM. Workplace violence in nursing: A concept analysis. J Occup Health 2021;63(1):e12226. [PMID: 33960074] [DOI:10.1002/1348-9585.12226] [PMCID: PMC8103077]

5. Cheung T, Yip PSF. Workplace violence towards nurses in Hong Kong: prevalence and correlates. BMC Public Health 2017;17(1):196. [PMID: 28196499] [DOI:10.1186/s12889-017-4112-3] [PMCID: PMC5310001]

6. Cavalcanti AL, Belo EDR, Marcolino EC, Fernandes A, Cavalcanti YW, de Carvalho DF, et al. Occupational Violence against Brazilian Nurses. Iran J Public Health 2018;47(11):1636-43. [URL:]

7. Weldehawaryat HN, Weldehawariat FG, Negash FG. Prevalence of Workplace Violence and Associated Factors Against Nurses Working in Public Health Facilities in Southern Ethiopia. Risk Manag Healthc Policy 2020;13:1869-77. [PMID: 33061720] [DOI:10.2147/RMHP.S264178] [PMCID: PMC7538000]

8. Babiarczyk B, Turbiarz A, Tomagová M, Zeleníková R, Önler E, Sancho Cantus D. Reporting of workplace violence towards nurses in 5 European countries - a cross-sectional study. Int J Occup Med Environ Health 2020;33(3):325-38. [PMID: 32235948] [DOI:10.13075/ijomeh.1896.01475]

9. Salavati, Daraie, Tabesh, Aradoei, Salavati. Workplace violence against nurses in Ahvaz educational hospitals. Nurs Midwifery J 2015;12(11):1018-27. [URL:]

10. Afkhamzadeh A, Faraji O. Assessment of exposure to workplace violence and related factors in nurses of teaching hospitals affiliated to Kurdistan University of Medical Sciences, 2016. Sci J Kurdistan Univ Med Sci 2020;25(5):113-22. [URL:] [DOI:10.52547/sjku.25.5.113]

11. Ghasemi M, Rezaei M, Fathi M, Mirzaei P, Joneidi N. Nurses exposed to physical violence in the university hospital's Baghiatallah. J Mil Med 2005;9(2):113-21. [URL:]

12. Gacki-Smith J, Juarez AM, Boyett L, Homeyer C, Robinson L, MacLean SL. Violence against nurses working in US emergency departments. J Nurs Adm 2009;39(7-8):340-9. [PMID: 19641432] [DOI:10.1097/NNA.0b013e3181ae97db]

13. Morphet J, Griffiths D, Plummer V, Innes K, Fairhall R, Beattie J. At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses. Aust Health Rev 2014;38(2):194-201. [PMID: 24670224] [DOI:10.1071/AH13189]

14. Liu X, Yang H, Hu Y, Zhou Y, Wang J, Dong L, et al. Incidence of workplace violence against nurses among Chinese hospitals: A meta-analysis. J Nurs Manag 2022;30(6):1490-501. [PMID: 34291858] [DOI:10.1111/jonm.13427]

15. Hemati Esmaeili M, Heshmati Nabavi F, Reihani H, Mazlom S, Taseeri A, Ebrahimi M, et al. The effect of workplace violence prevention program on attitudes of nurses towards the management of violence and aggression in patients and their families. J Health Promot Manag 2015;4(1):80-7. [URL:]

16. Bodagh M, Talebi A, Falahi B. Investigation of the effect of ACT-SMART on nurses' perceived level of violence management in emergency section. Prev Care Nurs Midwifery J 2020;9(4):39-46. [URL:] [DOI:10.52547/pcnm.9.4.39]

17. Dastur S, Zandi M, Karimian M. The effect of virtual self-management training in communication skills on the level of violence and occupational stress of emergency technicians at Shahid Beheshti University of Medical Sciences in 2021. J Health Saf Work 2024;14(1):105-18. [URL:] [DOI:10.18502/jhsw.v14i1.17125]

18. Khan MN, Khan I, Ul-Haq Z, Khan M, Baddia F, Ahmad F, et al. Managing violence against healthcare personnel in the emergency settings of Pakistan: a mixed methods study. BMJ Open 2021;11(6):e044213. [PMID: 34130958] [DOI:10.1136/bmjopen-2020-044213] [PMCID: PMC8208019]

19. Kalbali R, Jouybari L, Derakhshanpour F, Vakili MA, Sanagoo A. Impact of anger management training on controlling perceived violence and aggression of nurses in emergency departments. J Nurs Midwifery Sci 2018;5:89-94. [URL:] [DOI:10.4103/JNMS.JNMS_46_18]

20. Liu W, Zhao S, Shi L, Zhang Z, Liu X, Li L, et al. Workplace violence, job satisfaction, burnout, perceived organisational support and their effects on turnover intention among Chinese nurses in tertiary hospitals: a cross-sectional study. BMJ Open 2018;8(6):e019525. [PMID: 29886440] [DOI:10.1136/bmjopen-2017-019525] [PMCID: PMC6009508]

21. Bezerra CT, Grande AJ, Galvão VK, Santos DHMd, Atallah ÁN, Silva V. Assessment of the strength of recommendation and quality of evidence: GRADE checklist. A descriptive study. Sao Paulo Med J 2022;140(6):829-36. [URL:] [DOI:10.1590/1516-3180.2022.0043.r1.07042022]

22. Buterakos R, Keiser MM, Littler S, Turkelson C. Report and Prevent: A Quality Improvement Project to Protect Nurses From Violence in the Emergency Department. J Emerg Nurs 2020;46(3):338-44.e7. [PMID: 32389206] [DOI:10.1016/j.jen.2020.02.010]

23. de la Fuente M, Schoenfisch A, Wadsworth B, Foresman-Capuzzi J. Impact of behavior management training on nurses' confidence in managing patient aggression. J Nurs Adm 2019;49(2):73-8. [PMID: 30633062] [DOI:10.1097/NNA.0000000000000713]

24. Baig L, Tanzil S, Shaikh S, Hashmi I, Khan MA, Polkowski M. Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi. Pak J Med Sci 2018;34(2):294-9. [PMID: 29805396] [DOI:10.12669/pjms.342.14432] [PMCID: PMC5954367]

25. Shaikh S, Shahzad H, Khan M, Baig L, Jamali S, Hashmi I, et al. Effect of low-cost interventions to reduce the incidence of violent events in two public sector tertiary-care emergency departments, Pakistan. East Mediterr Health J 2022;28(2-2022). [PMID: 35304911] [DOI:10.26719/emhj.22.026]

26. Sadatmahaleh MM, Khoshknab MF, Rahguy A, Arsalani N, Biglarian A. Effect of workplace violence management program on the incidence. Adv Nurs Midwifery 2019;28(1):27-33. [URL:]

27. Sharifi S, Shahoei R, Nouri B, Almvik R, Valiee S. Effect of an education program, risk assessment checklist and prevention protocol on violence against emergency department nurses: A single center before and after study. Int Emerg Nurs 2020;50:100813. [PMID: 32061533] [DOI:10.1016/j.ienj.2019.100813]

28. Rahimi A, Arsalani N, Faiiahi-Khoshknab M, Biglarian A. The effect of communication skills training on violence against nurses in the hospitals affiliated to the Social Security Organization in Isfahan Province. Iran J Nurs Res 2019;14(2):44-51. [URL:]

29. Chang Y-C, Hsu M-C, Ouyang W-C. Effects of integrated workplace violence management intervention on occupational coping self-efficacy, goal commitment, attitudes, and confidence in emergency department nurses: a cluster-randomized controlled trial. Int J Environ Res Public Health 2022;19(5):2835. [PMID: 35270527] [DOI:10.3390/ijerph19052835] [PMCID: PMC8910583]

30. Wu J-C, Chen H-Y, Hsieh JL, Clinciu DL, Tung H-H. Enhancing health care personnel's response to ER violence using situational simulation. Clin Simul Nurs 2019;28:6-14. [URL:] [DOI:10.1016/j.ecns.2018.12.003]

31. Ming J-L, Huang H-M, Hung S-P, Chang C-I, Hsu Y-S, Tzeng Y-M, et al. Using simulation training to promote nurses' effective handling of workplace violence: a quasi-experimental study. Int J Environ Res Public Health 2019;16(19):3648. [PMID: 31569382] [DOI:10.3390/ijerph16193648] [PMCID: PMC6801794]

32. Senz A, Ilarda E, Klim S, Kelly AM. Development, implementation and evaluation of a process to recognise and reduce aggression and violence in an Australian emergency department. Emerg Med Australas 2021;33(4):665-71. [PMID: 33336468] [DOI:10.1111/1742-6723.13702]

33. Lamont S, Brunero S. The effect of a workplace violence training program for generalist nurses in the acute hospital setting: A quasi-experimental study. Nurse Educ Today 2018;68:45-52. [PMID: 29885569] [DOI:10.1016/j.nedt.2018.05.008]

34. Baby M, Gale C, Swain N. A communication skills intervention to minimise patient perpetrated aggression for healthcare support workers in New Zealand: A cluster randomised controlled trial. Health Soc Care Community 2019;27(1):170-81. [PMID: 30175538] [DOI:10.1111/hsc.12636]

35. Touzet S, Occelli P, Denis A, Cornut P-L, Fassier J-B, Le Pogam M-A, et al. Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study. BMJ Open 2019;9(9):e031054. [PMID: 31492791] [DOI:10.1136/bmjopen-2019-031054] [PMCID: PMC6731840]

36. Al-Ali NM, Al Faouri I, Al-Niarat TF. The impact of training program on nurses' attitudes toward workplace violence in Jordan. Appl Nurs Res 2016;30:83-9. [PMID: 27091259] [DOI:10.1016/j.apnr.2015.11.001]

37. Kang J, Kim J-I, Yun S. Effects of a cognitive rehearsal program on interpersonal relationships, workplace bullying, symptom experience, and turnover intention among nurses: A randomized controlled trial. J Korean Acad Nurs 2017;47(5):689-99. [PMID: 29151565] [DOI:10.4040/jkan.2017.47.5.689] []