Xie Renting, Timmins Fiona, Zhang Mengting, Zhao Jinbo, Hou Yongchao
School of Nursing, Shanxi University of Chinese Medicine, Taiyuan, China.
The Emergency Department of Second Hospital of ShanXi Medical University, Taiyuan, China.
J Adv Nurs. 2025 Aug;81(8):4500-4518. doi: 10.1111/jan.16708. Epub 2025 Jan 23.
To synthesise how ED crowding contributes to patient-initiated violence against emergency nurses.
Framework synthesis.
A systematic literature search was conducted in the PubMed, PsycINFO, CINAHL and Scopus databases, covering articles up to 21 March 2024.
A total of 25 articles were reviewed, evaluating study quality using the Crowe Critical Appraisal Tool and employing a framework synthesis approach to chart and synthesise data.
The review identifies key factors linking emergency department crowding to patient-initiated violence, focusing on crowding conditions, vulnerable populations and adverse outcomes. It emphasises the importance of multidimensional assessments, including input, throughput, output stages and staffing characteristics. Special attention is needed for patients with severe symptoms who are triaged into lower priority categories, as their perceptions of injustice and dissatisfaction may increase the risk of aggressive behaviour. However, limited information is available regarding the perspectives of patients' family members.
Accurate assessments of emergency department crowding and a thorough understanding of cognitive and emotional changes in high-risk patients are essential to develop strategies to manage patient-initiated violence effectively.
This review improves emergency nurses' understanding of the dynamics of patient-initiated violence in crowded emergency departments, equipping them with knowledge to better anticipate and respond to such incidents. It also offers insights that are crucial for enhancing nursing practices and ensuring workplace safety, thereby supporting the development of future emergency safety strategies.
As this is a systematic review and framework synthesis, there was no direct patient or public involvement.
综合阐述急诊科拥挤如何导致患者对急诊护士发起暴力行为。
框架综合法。
在PubMed、PsycINFO、CINAHL和Scopus数据库中进行了系统的文献检索，涵盖截至2024年3月21日的文章。
共审查了25篇文章，使用克劳批判性评估工具评估研究质量，并采用框架综合法对数据进行图表绘制和综合分析。
该综述确定了将急诊科拥挤与患者发起的暴力行为联系起来的关键因素，重点关注拥挤状况、弱势群体和不良后果。它强调了多维评估的重要性，包括输入、 throughput、输出阶段和人员配置特征。对于被分诊到较低优先级类别的重症患者需要特别关注，因为他们的不公正感和不满情绪可能会增加攻击行为的风险。然而，关于患者家属观点的信息有限。
准确评估急诊科拥挤情况并深入了解高危患者的认知和情绪变化对于制定有效管理患者发起暴力行为的策略至关重要。
本综述提高了急诊护士对拥挤急诊科中患者发起暴力行为动态的理解，使他们具备更好地预测和应对此类事件的知识。它还提供了对于加强护理实践和确保工作场所安全至关重要的见解，从而支持未来急诊安全策略的制定。
由于这是一项系统综述和框架综合研究，没有直接的患者或公众参与。
