The Lived Experience: How Emergency Department Nurses Resolve Emotional Pain after Patient Perpetrated Workplace Violence

Background: Patient perpetrated workplace violence (PPWPV) is recognized as a high risk against Registered Nurses (RN) and can result in unresolved emotional pain. Sensitizing framework for this study was the Theory of the Nurse as Wounded Healer (NWH) which explored recognition, transformation, and transcendence of emotional pain after PPWPV. 

Aim: The aim was to: 1) describe the ED RNs thoughts, feelings, and behaviors after experiencing PPWPV.

Methods: After IRB approval, descriptive phenomenology with purposive sampling allowed for recruitment of thirteen ED RNs in southeast US who reported PPWPV. Semi-structured interviews were audio-taped and transcribed verbatim. Content analysis and constant comparison identified different codes and themes developed.

Results: Four themes were identified:  Feelings: anger, fear, sadness, helplessness, seeking revenge, dissociating and distancing themselves emotionally from patients and environment. Working in the ED: perceptions of peer support were high; but administrative and safety support perceptions were low. Perceptions included upper level administrators lacked understanding and security was not as ‘present’ as needed. Crisis intervention classes were not helpful. Changes: the ED RN discussed both physical and psychological changes in themselves and their peers after PPWPV. Coping: Both effective and ineffective resolutions after PPWPV were found. Effective methods included humor, exercise, and talking to the facility’s employee health program therapists, administrators, peers, family or friends. Ineffective methods included excessive alcohol intake, smoking, eating too much, and depending on prescription medications for stress and sleep.

Conclusions: The ED RN may experience PPWPV that can have negative ramifications on their emotions. The NWH theory promotes recognition of emotional pain. Nurses need to be open, supportive of the team, and verbalize feelings after PPWPV. The ED RNs wanted administration policies that require strict enforcement by nurses, patients, and families. Nurses wanted written policies to ensure legal protection and guidance. The nurses wanted administrators to be more visible in their stance against PPWPV. Additional studies are needed to examine effective resolution of emotional pain after PPWPV, and to compare ED RN satisfaction with administration support after PPWPV.