An integrative literature review of interventions to reduce violence against emergency department nurses.

AIM: To critique the evidence that underpins interventions intended to minimise workplace violence directed against emergency department nurses, to inform researchers and policy makers regarding the design, development, implementation and evaluation of emergency nursing anti-violence and counter-violence interventions.
BACKGROUND: Workplace violence perpetrated against emergency department nurses is at least continuing and at worst increasing. Occupational violence has detrimental effects on job satisfaction, retention and recruitment, and the quality and cost of patient care.
DESIGN: An integrated literature review.
METHOD: Searches of the Cochrane Library, CINAHL, MEDLINE and the Joanna Briggs Institute between 1986-May 2007. Included articles were appraised and then synthesised into a narrative summary.
RESULTS: Ten primary research studies were included. Interventions were classified as environmental, practices and policies, or skills. While each study has useful information regarding the implementation of interventions, there is no strong evidence for their efficacy.
CONCLUSIONS: The weight of effort is still directed towards defining the phenomenon rather than addressing solutions. Studies that assessed the efficacy of a single intervention failed to take account of context; and participatory context-driven studies failed to provide generalisable evidence. Concerted multi-site and multi-disciplinary, action-oriented research studies are urgently needed to provide an evidence base for the prevention and mitigation of violence perpetrated against emergency department nurses. RELEVANCE TO CLINICAL PRACTICE: The investigation of interventions rather than repeatedly redefining the problem and directing resources into debating semantics or differentiating 'degrees' of violence and aggression is recommended. This review unambiguously identifies the gap in research-based interventions.