Promoting holistic approaches to management of violence in the ED—a response to Ramacciati (2023)

We were very pleased to receive a response to our paper (Timmins et al., 2023) that highlighted current issues in relation to the nursing management of emergency department (ED) violence (Ramacciati, 2023). Moreover that the position paper achieved its primary aim in terms of “excellently achieved its goal of stimulating reflection on the causal factors of violence against nurses in emergency departments and discussing possible solutions and strategies for largely unresolved issues” (Ramacciati, 2023). This was most heartening for us. Understandably, this author echoes the growing concern among the nursing profession that there is a potential increase in this phenomenon, with growing frustration about ways to tackle the problems. They also, like us, agree that the management approach needs to be holistic taking account of the multiplicity of personal and contextual factors that contribute to its occurrence. Indeed, we drew upon the important work of Ramacciati et al. (2018) within our paper, noting that from an extensive study of Italian nurses (n = 15,000), these authors were able to determine a conceptual framework for understanding ED violence which gave equal weighting to the importance of environmental and organisational factors alongside factors within the nurse and patient considerations. The potential for the nurse to trigger violence, either by presence or action, was an interesting consideration to emerge from this conceptual work, and one that must be given careful consideration in management and policy approaches for the future. Certainly, as we pointed out in our paper, there are key contributing patient factors such as intoxication and cognitive/mental health issues, however the contribution of the environment, including other key issues such as overcrowding and queuing needs greater consideration in approaches to the management of ED violence. In fact, ED nurses, when they are asked about triggers for ED violence state overwhelmingly that the environment is the major contributory factor (Angland et al., 2014). Ramacciati (2023) points out that the prevention and management of ED violence has been high on policy makers agendas for more than two decades, and yet the health services appear stifled in their success with operationalising these and reducing and addressing the issues. There are many reasons for this, including under-reporting, acceptance of ED violence as part of the job and nurses only seeking redress when real harm has been done (Timmins et al., 2023). However, Ramacciati (2023) reminds us that it is time to evoke considered action and begin to examine and address this phenomenon in a way that comprehensively considers the multifactorial contributors within the ED dynamic and one that fully supports both nurses and clients in their care. Indeed, the work of these authors (Ramacciati, 2023) is sure to make a significant contribution to this, first by their important conceptual outline that can inform our understanding of the phenomenon, but also through other more recent work including the development of a user-friendly system (a smartphone app) for reporting ED violence (Ramacciati et al., 2021).

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