Aggression and violence in the ED: issues associated with the implementation of restraint and seclusion

A number of surveys have reported that those who work in emergency departments (EDs) experience high levels of violence and aggression. Some suggest that 100% of emergency department nurses have, at some time, experienced workplace violence. This report summarises those data and highlights the under-reporting of violent incidents occurring in emergency departments. Current responses to such incidents are reviewed, with particular focus on the use of both unambiguous and ambiguous restraint practices and also on seclusion. Those practices are evaluated in the context of current policy. This review suggests that rather than continue with discussions about whether or not restraint and seclusion are appropriate management procedures in the emergency room, efforts should be directed towards development of best practice for initiating and managing the use of restraint when it is implemented.