Violence Against Emergency Department Nurses

Ethical Issues in Research

With the rise of violence in the workplace, and the prevalence of Emergency Department (ED) nurses that are assaulted verbally and/or physically while on duty, the following question needs to be answered: “is violence against nurses in the ED an issue that is more widespread than actually reported?” In order to answer this question, a research study needs to be done. This research study must follow the seven main principles of research ethics and be independently reviewed for validity. In the following material is a review of how this study follows the principles of ethics in research.

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Research Ethics Guidance

Ethics are principles and rules that help guide decisions and proper conduct as they relate to right and wrong, and what should be. In the past, many research projects were unethical such as withholding treatment, withholding information, treating patients poorly, injuring them, and even caused permanent disability and death (Grove, Gray, & Burns (2015). Because of these issues, a code of ethics in research was developed to help guide the researchers and research subjects alike, with informed consent and based on seven main principles that are important when conducting ethical research studies including: social and clinical value; scientific validity; fair subject selection; favorable risk-benefit ratio; independent review; informed consent; respect for potential and actual enrolled subjects (NIH n.d., Patient Recruitment, para 3)

Social and Clinical Value

According to the National Institute for Occupational Safety and Health, workplace violence is defined as “an act of aggression from offensive or threatening language to homicide” (Wolf, Delao, & Perhats, 2014). Violence is 3.8 times more prevalent in the healthcare setting and the ED is a highly susceptible area for it to occur due to high emotions, uncertainty, mental health problems in patients, drug addictions, and long weight times. Violence against the nurses can cause emotional and or physical distress and harm to the nurses and the patients they care for (www.ENA.org). Many nurses fail to report the violence due to several reasons such as: fear of reprisal from their employer or law enforcement; feeling it is ‘part of the job’; culture of acceptance; and feeling nothing will happen if they report anyway (www.ENA.org). By gaining insight and actual numbers of nurses who have been assaulted, more attention can be brought to the issue, prevention plans, support for those affected and more state legislation could be enacted to help stop the violence.

Scientific Validity

Violence against nurses in the ED setting is proven to cause emotional distress and burn-out in nurses because there is a culture of acceptance by the nurses that the ED is a high risk for violence due to the often high intensity of emotions and uncertainty at any given moment (Wolf et.al, 2014). To address the question “is violence against nurses in the ED an issue that is more widespread than actually reported?”.

The method chosen is a qualitative description exploratory design type questionnaire (Grove et.al, 2015) sent by email to randomly chosen hospital nursing directors in urban and rural hospitals asking several questions regarding the demographics where they work such as: what department do you work in; is your facility located in an urban or rural setting; level 1 Trauma or less; if they had experienced a verbal; physical or sexual type of assault in the past week; month, or year; what if any physical injures they experienced; did they report the incident and if not, why. The control group will be the non-ED nursing staff. Data between the two will be collected and compared between the two and compared against recent statistics of violence.

Fair Subject Selection and Informed consent

The subjects selected for the study will all be nurses from random hospitals throughout the US in rural and urban settings from comprehensive ED’s to Level 1 Trauma Centers. The nurses will be from the ED and from the other departments in the hospital, including intensive care, pediatrics, surgery, medical surgical departments and psychiatric departments. The questionnaire will be sent out June 1, 2019 to be collected by August 1, 2019 giving a time frame of 3 months to collect. The subjects are all given the information on the study and that are volunteering on their own without coercion and that their privacy will be maintained to prevent any possible reprisals from their employer. This will be attained through informed consent where the participant will be aware of the risks, benefits, purpose, methods, and alternatives to the study. The participant will also understand how this information and how it relates to their own clinical situation and that they are making a voluntary decision whether to participate or not

Favorable Risk-Benefit Ratio

The risk-benefit ratio for the participants in this study, is favorable, the email will be sent to randomly chosen healthcare organizations nursing directors to disperse among their nursing staff, and to be completed at their leisure with a 3 month or less date to complete.

Independent Review

Before the study begins, the independent review board (IRB) will review the study to decrease the potential conflicts of interest in the study, to make sure the study is acceptable ethically, the IRB, not vested in the study, will review the study proposal questioning it as needed (Grove et.al, 2015). The review panel will consist of risk management, two emergency department nurses, two medical surgical nurses, two medical ethics attorneys, and two ED physicians.

Respect for Potential and Enrolled Subjects

Participation in the study is voluntary and their privacy is respected. The participants have a right to participate at anytime before and during. The participants will be informed of the results of the study by email.

Conclusion

There are many steps to design an ethical research study. Independent research is accomplished by use of the seven main principles of research ethics, therefore the question of “is violence against nurses in the ED an issue that is more widespread than actually reported?”, ca be answered.

References

Grove, S. K., Gray, J. R., & Burns, N. (2015). Understanding nursing research: Building an evidence-

based practice. (6th ed.). St. Louis, MO: Elsevier/Saunders.

Gurney, D. (2014). Violence in the Emergency Care Setting: Position Statement. Retrieved from

https://www.ena.org/docs/default-source/resource-library/practice-resources/position-

statements/violenceintheemergencycaresetting.pdf?sfvrsn=49343551_8

Karigan, M. (2001, September). Ethics in Clinical Research: The Nursing Perspective. American Journal

of Nursing, 101(9), . Retrieved from http://www.nursingcenter.com

National Institutes for Health. (n.d.). Patient recruitment. Retrieved from https://www.cc.nih.gov/recruit/ethics.html

Wolf, L., Delao, A., & Perhats, C. (2014). Nothing changes, nobody cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care. Journal of Emergency Nursing, 40(4), 305–310. doi:10.1016/j.jen.2013.11.006