Hot town, summer in the city
Back of my neck getting dirty and gritty…
All around, people looking half dead
Walking on the sidewalk, hotter than a match head…
—The Lovin’ Spoonful
Summer and the heat that it brings have arrived. Heat has always seemed to be associated with an increase in aggression, agitation, hatred, and violence.1., 2., 3. The passing of the 40th anniversary of a very violent year, 1968, also is being marked this year. For those of us who remember the upheaval of 1968, the violence began in the spring when 2 great American leaders were assassinated and was followed by a summer during which protestors at the Democratic National Convention in Chicago were brutally beaten. The memories of that tragic year and how we thought the world should be still remain intense.
For some reason, people have found violence to be a method of “drawing” attention to them. ED nurses have probably experienced this phenomenon more than any other group of health care providers. Verbal abuse and physical assault are common in emergency departments.4., 5., 6. Many emergency nurses do not even report all incidents because it is perceived as being part of the job.7
The environment of the emergency department is full of stressors, including heightened emotions, prolonged wait times, and limited communication. The emergency department also must contend with the “nowhere else to take them” phenomenon. The homeless, intoxicated, mentally ill, and those with “unknown” problems are just a few of the types of patients who cannot be turned away.
Perceptions of both patients and staff play key roles in the escalation of violence in the emergency department.8 It is hard to ignore the local or world environments in which we live today. Culture, belief systems, and life experiences shape how ED staff, patients, and families perceive their “emergencies” and the stresses in their lives.
Because this is the environment in which we practice and summer and its heat are here again, what can we do? Research has brought this issue to the forefront, and many solutions have been proposed. Some of the suggested strategies include the following:4., 9.
•Early recognition of potentially violent patients and situations
•Use of well-developed verbal and nonverbal interpersonal skills
•Educated and trained security personnel
•Use of animals, especially dogs
•Physical restraint and sedation
•Legislation to protect staff and patients
•Research that identifies evidence of good workplace safety and patient care guidelines to prevent violence.
It is interesting to note that Ross-Adjie, Leslie, and Gillman8 strongly advocate for mandatory debriefings by skilled counselors after a stress-evoking incident such as the management of a violent patient.
Despite the summer’s heat and the stressors of the emergency department, one word of caution must be considered. It is important to always be sure that the patient’s violent behavior is not the result of a medical problem such as hypoglycemia or traumatic brain injury.
Whether the summer heat increases the workload in the emergency department has yet to be proven. It is one of those feelings we all get as emergency nurses. However, it is the “nature of our beast,” and we must learn how to manage it in a caring, compassionate, and professional manner, or we may become one of its victims.
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