Violence and aggression in A & E: recommendations for action

The problem of violence and aggression in health care settings has become a high-profile issue. Following the release of figures issued by the Health Services Advisory Committee (HSAC) which show nursing as the most dangerous profession in the UK, Frank Dobson, Health Secretary, urges health service managers to do everything they can to reduce violence. Violence is defined as any incident which puts a health care worker at risk and includes verbal abuse, threatening behaviour or assault by a patient or member of the public. It is suggested that most violent incidents within the hospital setting contain an intentional and, therefore, aggressive element. The theoretical background to the concept of aggression is explored to pinpoint its causes and identify the factors which originate its potential for harm. An analysis of the Accident and Emergency (A & E) environment with the conflicting demands of its workload highlights its potency for the creation of violent and aggressive behaviour towards its staff. In order to minimize its detrimental effects, this paper examines various approaches towards counteracting violence and aggression. It concludes that these methods fall into five major categories and details recommendations for action within these areas. The HSAC (1997) declares that it is possible to reduce the risk of violence by proactive management, underpinned by positive commitment from senior managers and staff at all levels.