Title of the Study

The title of the article framed by Tan, Lopez & Cleary (2015), does not provide a clear view to the reader about the phenomenon of research interest. Here the term “aggression” fails to highlight the source of aggression or who is getting the affected of such aggression (population group of interest). The tile also fails to clearly convey the context of the study; it only gives a vague reference towards aggression and nursing management in the emergency department (ED). The paper mostly deals with the perception of the nurses to address aggression coming from the patients and their careers in the ED. The paper however provides the paradigm or methodological approach undertaken (qualitative).

The title needs to be modified in such a way that it gives a direct insight if the aim of the research. For example, the paper published by Heckemann et al., in the year 2015 provides full insight about the nature of the study conducted, the target population and methodological approach undertaken, “The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting. A narrative review of current literature”.  

There are few themes generated in the literature review from the thematic analysis of the paper published by Tan, Lopez & Cleary in the year 2015. 

1. Impact of aggressive patients on nurses of ED
2. Nursing assessment of aggressive behaviours
3. Nursing management in order to deal aggressive behaviour
4. Organizational support to deal with aggressive behaviour

Not all the themes provide a logical sequence building to gap the knowledge in the research. The gap in the knowledge is, theme: nursing assessment of aggressive behaviours only highlights the problematic physiological state of the patients. However, this qualitative research fails to highlight dearth in the knowledge among the nurses which are responsible for the generation of aggressive behaviour of the nurses. The paper Zeller, Dassen, Kok, Needham & Halfens, 2012 highlighted lack of confidence among the care givers and deployment of inexperienced staff in the ED as two main factors for the generation of aggression among the patients in the ED. Moreover, the paper published by Angland, Dowling & Casey in 2014 showed significant involvement of environmental factors and communication factor in the development of violence and aggression among the ED patients. The effectiveness of communication factor in controlling patient aggression has been further highlighted in the study conducted by the Hahn, Hantikainen, Needham, Kok, Dassen & Halfens in the year 2012. 

The nursing perception however did not highlighted that how the application of creating and refreshing visual aid helps in controlling the negative patient behaviour waiting in the long queue to get admitted in the emergency department (Nanda, Chanaud, Nelson, Zhu, Bajema & Jansen, 2012).  

Themes Generated in Literature Review

The significance of the study is however been properly discussed. The authors are of the opinion that this is first every study in accessing the perception of nurse in managing aggressive behaviour of the patients in Singapore emergency department scenario. The quality of the sources that has been used to support the literature review is authentic. However, few sources are more than 10 years old.

The theoretical/ conceptual framework has been properly used to guide the study. However, the conceptual framework did not highlight the difference in perspectives among the male and the female nurses to control patient aggression.

The group or population in the research paper includes 10 registered nurses (RN) from the ED of an acute public hospital in Singapore.

The setting was RN from ED and the sample inclusion criteria was nurses who have previous contact with aggressive patients and have an experience of less than three months in the ED. The setting however did not mentioned the patient rush in the emergency section per day and in which point of time in a day, maximum flow of the patients is being experienced like the one done in Angland, Dowling & Casey, 2014. Moreover, 80% of the nurses (8 out of 10) were female and hence there was lack of balance among the gender.

The approaches that were used to gain access to the site or to recruit participants include approval from the National Healthcare Group Domain Specific Review Board. Advertisement flyers were distributed along with staff briefing was undertaken in order to include potential participants. 

The best possible method is not used for sampling in order to enhance information richness and address the needs of the study. The study selected a major Singapore general actue hospital with 24 hours ED. However, if the study is being performed among at least five large hospitals selected from a large population of the two of the busy region of Singapore, then the study might have been more rich (Lachs et al., 2013).

Sample size was not adequate towards drawing significant conclusion regarding nurse perception. The saturation is achieved when the content of the interview became repetitive and it became unlikely to generate something new information from the further collection of data. However, with such a low sample size centered on the same hospital setting, saturation is bound of arrive fast, leading to bias response (Bean, Stafford & Brashares, 2012).   

Significance of the Study

Data Collection

The methods of gathering data appropriate as the study conducted interview via taking consent from the participants (Jacob & Furgerson, 2012)

There was no attempt to achieve data triangulation as the study was conducted via selecting the focus group from one hospital only. This restricted the scope along with transferability.

The collection of data was done via open-ended interview; however, the research paper lacks the appendix, stating the interview questionnaire. The interview was recorder digitally and was conducted on a mutually agreed venue. However the interview was done in English. Staffs who were employed to collect the data is not mentioned in the research paper.Tthe data however, collected was relevant based on the aim of the research. 

Data Analysis

Data collection and analysis was done simultaneously. The verbatim transcript of the collected data was analysed on basis of the tenets of the thematic analysis in order to generate the theme. However, the paper does not follow few steps of the thematic analysis as described below

Figure: Process of Thematic Analysis and Content Analysis

Source: Vaismoradi, Turunen & Bondas, 2013)

The data management and data analysis methods are not sufficiently described. The paper did not highlighted the process it took to overcome the biasness. The type of the data gathered is compatible with the data analysis and research tradition. The analysis failed to yield an appropriate result as this thematic study failed to highlight other portions of the nursing aggression like evaluation of the coping strategies undertaken by the nurses who are the victims of aggression and different types of aggression experienced in the ED during high patient pressure (Edward, Ousey, Warelow & Lui, 2014). The analytic procedures suggest the possibility of biases because they have only interviewed people who have completed 2-8 years in the ED and not the experienced nurses who have yearlong experience. According to the Edward, Ousey, Warelow & Lui, 2014, less experienced and younger staffs are at more risk of getting target of violence at the workplace in comparison to the old and the experience registered nurses. The study also fails to highlight that whether the male nurses were specially a target of the physical assault and whether the night-shift nurses or the nurses working during the week-ends are the target of patient aggression and the coping strategies used by them (Shiao, Tseng, Hsieh, Hou, Cheng & Guo, 2010). 

There is no mention regarding how the rights of participants have been protected. However, the participants were asked to sign a consent form before taking participation in the interview and the purpose of the interview was explained to them. Ethical approval was obtained from National Healthcare Group Domain Speci?c Review Board but there is no mention of the permission obtained from the concerned hospital. The interview was carried on a mutually agreed location and there was no clear evidence regarding if the interview was carried within the hospital premises or within the working hours of the participant nurses 

Methodology

References

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Angland, S., Dowling, M., & Casey, D. (2014). Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study. International emergency nursing, vol. 22(3), pp. 134-139. https://doi.org/10.1016/j.ienj.2013.09.005

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