Workplace Violence Against Emergency Department Nurses in Low- and Middle-Income Countries: A Systematic Review and
Aekkachai Fatai1, Chakrit Sattayarom2, Wiwat Laochai3
1Princess Agrarajakumari Faculty of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand.
Aim:
Workplace violence (WPV) against emergency department (ED) nurses is a global concern; however, evidence from low- and middle-income countries (LMICs) remains fragmented despite substantial differences in healthcare infrastructure, staffing and policy capacity compared with high-income settings. This review aimed to synthesise the existing literature to identify the prevalence, risk factors, types and impacts of workplace violence against emergency nurses in low- and middle-income countries.
Design:
Systematic review and meta-analysis.
Methods:
This review was conducted following PRISMA guidelines. Studies were included if they employed quantitative or mixed-methods designs, focused on emergency nurses in LMICs, and reported WPV prevalence. Quality assessment was conducted using the JBI Critical Appraisal Checklist. A random-effects meta-analysis was performed to examine the prevalence of WPV.
Data Sources:
Four databases, CINAHL, PsycINFO, PubMed and Google Scholar, were searched for studies published between 2015 and 2025.
Results:
Eleven cross-sectional studies from Africa, Asia, Europe-Asia and South America were included, involving sample sizes ranging from 80 to over 20,000 ED nurses. The pooled prevalence of any WPV was 79% (95% CI: 69%-86%). Verbal violence was the most common form, affecting 82% of nurses (95% CI: 71%-89%). Physical violence was 40% (95% CI: 22%-63%), with substantial heterogeneity across studies. The main risk factors included long waiting times, overcrowding, inadequate staffing and poor security measures. WPV resulted in significant physical, psychological and professional consequences, including stress, depression, burnout and increased turnover intentions.
Conclusion:
WPV against ED nurses in LMICs is widespread and severe, affecting 79% of nurses, with verbal abuse being the most prevalent.
Implications For The Profession And/Or Patient Care:
The high prevalence rates highlight the urgent need for targeted prevention strategies, improved workplace safety measures and comprehensive support systems for emergency nurses.
Reporting Method:
We have adhered to relevant EQUATOR guidelines, particularly the PRISMA checklist.
Patient Or Public Contribution:
No patient or public contribution.
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