Clinical Summary: Attitudes of Emergency Department Nurses Toward Violent Patients With Mental Illness
Emergency nurses are often the first clinicians to confront aggression from patients with mental illness, and their attitudes can shape whether they use person-centered strategies or containment. In this study, nurses discounted multiple common contributors to aggression and showed mixed views on medication, de-escalation, seclusion, and restraint, highlighting a practical gap in ED violence-management readiness.
Key Findings
- Among 33 respondents, 18 (54.5%) had a positive attitude, while the rest had a neutral attitude.
- Of the respondents, 51.5% were male; all the respondents were aged 20–30 years; 87.9% were BSc educated, and 57.6% had 1–3 years of experience in psychiatry.
- The MAVAS total score was not correlated with age, sex, education level, clinical experience, or psychiatric experience.
- The mean scores of all 5 statements in the internal domain were >2.5, all 3 statements in the external domain were >2.5, and all 5 statements in the situational/interactional domain were >2.5, indicating disagreement that patient, environmental, or immediate interactional factors contributed to aggression.
- Respondents disagreed that medications were a valuable approach for treating violent patients (mean=3.3), while agreeing with negotiation and showing agreement-to-disagreement regarding the use of de-escalation in preventing violence.
This ED nursing sample showed broadly neutral-to-positive overall attitudes but did not endorse many established causes of aggression and had inconsistent views about how violence should be managed. In practice, that pattern supports targeted ED education that links causes of aggression to appropriate use of negotiation, de-escalation, medication, seclusion, and restraint.
Practice Implications
- Do not assume ED nurses recognize the role of patient, environmental, and staff-interaction factors in aggression; training should explicitly address these contributors because mean scores in the internal, external, and situational/interactional domains were >2.5.
- Include medication use in aggression-management education, as respondents disagreed that medications were a valuable approach for treating violent patients (mean=3.3) and also disagreed with more frequent use of medications in aggressive patients.
- Strengthen teaching on nonphysical strategies with practical application, since respondents agreed with negotiation but had mixed views on de-escalation and did not believe improved one-to-one communication could reduce aggression.
- Review local protocols for seclusion and restraint, because respondents disagreed that seclusion was one of the most effective ways to deal with this behavior, disagreed that patients were usually restrained for their own safety, and were divided on whether seclusion should be discontinued.
