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Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base
INTRODUCTION: Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to qu...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861170/ https://www.ncbi.nlm.nih.gov/pubmed/31814780 http://dx.doi.org/10.2147/OAEM.S192884 |
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author | Richardson, Sandra K Ardagh, Michael W Morrison, Russell Grainger, Paula C |
author_facet | Richardson, Sandra K Ardagh, Michael W Morrison, Russell Grainger, Paula C |
author_sort | Richardson, Sandra K |
collection | PubMed |
description | INTRODUCTION: Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same. AIM: To identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient. METHODS: A meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice. RESULTS: An initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested. CLINICAL IMPLICATIONS: The lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice. CONCLUSION: There is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified. |
format | Online Article Text |
id | pubmed-6861170 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-68611702019-12-06 Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base Richardson, Sandra K Ardagh, Michael W Morrison, Russell Grainger, Paula C Open Access Emerg Med Review INTRODUCTION: Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same. AIM: To identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient. METHODS: A meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice. RESULTS: An initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested. CLINICAL IMPLICATIONS: The lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice. CONCLUSION: There is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified. Dove 2019-11-12 /pmc/articles/PMC6861170/ /pubmed/31814780 http://dx.doi.org/10.2147/OAEM.S192884 Text en © 2019 Richardson et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Review Richardson, Sandra K Ardagh, Michael W Morrison, Russell Grainger, Paula C Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
title | Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
title_full | Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
title_fullStr | Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
title_full_unstemmed | Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
title_short | Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
title_sort | management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861170/ https://www.ncbi.nlm.nih.gov/pubmed/31814780 http://dx.doi.org/10.2147/OAEM.S192884 |
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