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What communication techniques do ED nurse utilise to minimise patient violence & aggression?

Related Literature

Behaviours of aggression and violence is quite common in the acute hospital settings especially in the emergency departments (ED). This is often associated with low level of resistance along with hitting out or other forms of physical assault. Most of the healthcare professionals, especially nurses, think that it is part of the job to simply tolerate this type of behaviour (Patterson et al. 2013). However it can result in serious injury to the patient, staff, other patients or visitors, and contributes to staff stress and work absence. In the emergency department the possible cause of high risk of violent episodes in the ED includes exposure to lack of communication between patient and nursing staff and demanding behaviour or attitude of patients and their family members. Hence, addressing these risk factors might be a solution to control aggressive events and manage aggressive patients in the ED (Jones, Podila, and Powers 2013). The elevated incidence of violence and aggression in the ED is the primary research problem. The main goal that is identified in the research paper is to assess the role of therapeutic nursing communication skills in managing aggressive patients coming to the ED. This paper therefore aims to discuss the research paradigm including the methodology of the study. In addition the paper elaborates the method of data collection and data analysis that is carried out in this paper.

Design strategy 

In most cases, within paradigms the research is conducted, which in turn represent the particular way the researcher thinks about their subject matter and which they share with similar minds. In an area of research which is largely under-researched additionally no significant documented theories are available from which hypothesis can be developed, in such cases, the research can only begin by induction. The beginning occurs with collection of facts and then trying to find some order in them in a process known as inductive reasoning. This inductive reasoning is generally open-ended in addition with exploratory observations and measures that detects patterns in association with regularities. This formulates certain tentative hypothesis which can be explored and this ends up with development of some general conclusions or theories. In cases where the knowledge sought is inseparable from the situational and personal aspects of those involved, some degree of generalization can be achieved by making allowances for local and personal influences.

The research question developed here for the conduction of the study includes that what are the communication techniques that can be implemented in the emergency department by the nurses in order to minimise the patient violence and aggression. According to this the PICO question is developed by following the PICO framework. This is as follows:

Research Methodology

P- Aggressive patients in the Emergency Department

I-Communication techniques used by the ED nurses

C- No communication strategies

A qualitative study approach was implemented in order to conduct a search on the existing literature of the subject of the present study. This was preliminarily conducted using the PubMed database. The search terms that were used included communication, emergency department, violence, aggression, intervention. These terms were used together using the Boolean operators such as AND and OR. As a research question needs to be developed using the study, a PICO framework needs to be utilised in order to develop the literature search strategies. The CINAHL database is also used to retrieve the articles. The search was conducted between the time frame of 2013 and 2017. All the selected articles that were selected were written in English.

The inclusion criteria that were considered included that the papers were related to the communication techniques, it was related to the techniques used in emergency department, the articles related should be concerned about the patients showing violence and aggression. The exclusion criteria included those which were not related to the interventions carried out in the emergency department. Articles reporting about other interventions other than communication intervention must be excluded.

There were initially 51 papers recruited for the study that were retrieved from the databases of PubMed and CINAHL. 26 were collected from PubMed and 25 were collected from CINAHL. Out of these ten papers were excluded because of the duplication present. There were 41 papers considered which were potentially relevant. Out of these 25 papers were excluded which were based on the abstract of the paper. After this 16 papers were considered which were relevant potentially and the full text of the paper was retrieved. Out of these 16 papers, there were five papers that were excluded after reading the paper and the analysis of the full text was conducted. One of the potentially relevant paper were excluded as full text of the paper was not found. Finally ten papers were included in the review.

The methods of data collection needs to be minimum that is consistent along with the theoretical, the philosophical and the methodological assumptions of the study. The methods of data collection needs to be involved in the combination of the qualitative methods that involves the pilot scale interviews along with the questionnaire surveys along with the focus group interviews. For collection of data along with the efficient data collection, the technique of sampling is recommended. The technique of sampling is very complicated in case of qualitative research as there are many variations of qualitative sampling techniques. The literature and much confusion and overlapping of sampling types particularly in the case of purposeful and theoretical sampling.

Data Collection

The data collection was conducted by retrieving the articles from the databases and then going through each of the article. The inclusion and the exclusion criteria will be implemented after which following the above mentioned selection criteria 10 papers will be finally selected that were related to the communication techniques used by the nurses of the emergency department to handle patients with violence and aggression. As the PICO framework will be used for this study, the data will be collected in relation to the research question. In reference to the PICO format, the following facet analysis will be done for data collection (O'hagan et al. 2014).






Health professionals of emergency department


Approaches to reducing violence in ED


Safety, violent episode decrease

Accident and emergency


Aggressive patient

Approach avoidance

Appraisal assessment


Violent behaviour

Prevention by communication  

Well being


Workplace violence

Therapeutic communication




To manage

To prevent

To provide

To support


In case of data analysis, the qualitative researchers are generally involved in interpretation of the data by coding, which by systematic data searching identifies or categorizes the specific actions or characteristics that are observable. These actions further become the key variables of the study. In terms of the collected information, researchers strive to make sense of their collected data. Data is interpreted in one of two ways which involves holistic approach or through coding. Holistic analysis generally fails to break the evidence into parts, however it draws conclusions based on the text as a whole. A typical approach to qualitative data analysis includes the following: 1) Raw Data approach is used in which the transcript or abridged transcripts might be presented that shows how the participants responded to the specific questions. Such responses might be categorized in accordance to the specified criteria. 2) Data description is involved in providing the summary statements of respondent’s comments. This is conducted using themes and subheadings and by making quotations only where absolutely necessary 3) After description, the interpretive process suggests the meaning of findings in the study and aims at aims at providing understanding. It is rooted in the raw data.

The data analysis shows that the title and abstract of articles were analysed first to determine its relevance with the research question. In the next phase, the full-text articles were reviewed against inclusion and exclusion criteria to take decision regarding inclusion of the articles for literature review. Critical analysis of articles has been done by evaluating credibility, reliability and applicability of research findings (Patterson et al. 2013).


In conclusion, it can be seen that the paper summarizes the outcomes from the literature review of nursing communication interventions to manage aggressive patients in the ED. On the basis of the review and analysis of research literature, it was be deduced that therapeutic communication skills along with the training programs are related to strategy of de-escalation. This has been identified as one major nursing management strategy in order to cope with aggressive behaviour in ED. The research aimed to address the problem of high prevalence of violence and aggression in the ED. The literature review also focused in the evaluation of the effectiveness of communication strategies on aggression management as patient-staff factors was identified as one of the risk factor of aggression. The review successfully shows the potential of communication training. However, more studies are needed in the future to get validated findings that reports about reduction in violence episodes in patient post intervention.


ALBashtawy, M., Al-Azzam, M., Rawashda, A., Batiha, A.M., Bashaireh, I. and Sulaiman, M., 2015. Workplace violence toward emergency department staff in Jordanian hospitals: a cross-sectional study. Journal of Nursing Research, 23(1), pp.75-81.

Angland, S., Dowling, M. and Casey, D., 2014. Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study. International emergency nursing, 22(3), pp.134-139.

Copeland, D. and Henry, M., 2017. Workplace violence and perceptions of safety among emergency department staff members: experiences, expectations, tolerance, reporting, and recommendations. Journal of trauma nursing, 24(2), pp.65-77.

Hahn, S., Müller, M., Hantikainen, V., Kok, G., Dassen, T. and Halfens, R.J., 2013. Risk factors associated with patient and visitor violence in general hospitals: Results of a multiple regression analysis. International journal of nursing studies, 50(3), pp.374-385.

Jones, F., Podila, P. and Powers, C., 2013. Creating a culture of safety in the emergency department: the value of teamwork training. Journal of Nursing Administration, 43(4), pp.194-200.

Miller, E., McCaw, B., Humphreys, B.L. and Mitchell, C., 2015. Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach. Journal of Women's Health, 24(1), pp.92-99.

O'hagan, S., Manias, E., Elder, C., Pill, J., Woodward?Kron, R., McNamara, T., Webb, G. and McColl, G., 2014. What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), pp.1344-1355.

Patterson, P.D., Pfeiffer, A.J., Weaver, M.D., Krackhardt, D., Arnold, R.M., Yealy, D.M. and Lave, J.R., 2013. Network analysis of team communication in a busy emergency department. BMC health services research, 13(1), p.109.

Phillips, J.P., 2016. Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), pp.1661-1669.

Riley, J.B., 2015. Communication in nursing. Elsevier Health Sciences.

Spector, P.E., Zhou, Z.E. and Che, X.X., 2014. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies, 51(1), pp.72-84.

White, C.M., 2016. Social media, crisis communication, and emergency management: Leveraging Web 2.0 technologies. CRC press.

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