The Surprising Link Between Patient Anxiety and Violence in the Emergency Department

Many healthcare leaders may not realize that the anxiety their patients feel about not knowing what's happening, might be driving them toward violence.

New research published in the Journal of Emergency Nursing in 2025 examined 315 emergency department patients and found that "intolerance of uncertainty" is a major predictor of violence tendency.

What's Intolerance of Uncertainty?

Think about what it’s like to be a patient in an Emergency Department (ED). You are in pain. You don't know what's wrong. You don't know how long you'll have to wait for answers. You don’t know if this is a minor setback or a long term issue. You don’t know if you’ll be admitted or discharged. That uncertainty, and how staff recognize and address it, can significantly impact their tendency toward violence. 

Researchers have identified two specific types of anxiety that escalate risk of violence:

Prospective anxiety: Worry about the unknown and what's coming next. "What if they find something serious?" "What will my outcome look like?"

Inhibitory anxiety: The paralysis of not knowing what actions to take or what to do right now. "Should I ask them again?" "Are they ignoring me?" 

Both types of anxiety were identified as significant predictors of violence tendency, along with other factors, such as being single, having a lower education level, and overall dissatisfaction with emergency services. 

A Costly Communication Gap

One key finding that really matters: patient satisfaction was one of the strongest predictors of violence tendency.

The research shows that patients who feel dissatisfied with their ED experience show significantly higher violence risk. And the cause of  that dissatisfaction is often linked to communication—or the lack of it.

When patients lose certainty about what's happening, why others are receiving care but they are still waiting, or what to expect next, they often become angry. However, when staff are transparent, anticipate concerns, and provide clear information about processes, wait times, and treatment plans, patients and families typically respond more reasonably. 

The importance of early, intentional, proactive communication isn’t just about being nice. It’s actually an evidence-based violence prevention strategy.

Who's at Higher Risk?

The research identified some demographic patterns worth understanding. Lower education levels and being single both correlated with higher violence tendency, likely relating to the lack of a support systems or stress-coping mechanisms.

But don't miss the bigger point: these aren't just interesting data points. They're indicators that certain patients may need more communication, more reassurance, and more proactive information—not less.

What This Means for Your Safety Program

The researchers recommend three concrete actions:

First, fix the communication gaps. Staff and providers in the ED need to understand that providing clear information isn't just good bedside manner. It’s violence prevention. Explaining processes, acknowledging uncertainty, and demonstrating empathy are safety protocols.

Second, measure what matters. Patient satisfaction isn't just about HCAHPS scores. It's a leading indicator of violence risk.

Third, address the anxiety, before it becomes anger. Most workplace violence programs focus on response or de-escalation after someone's already agitated. This research highlights the importance of reducing the uncertainty that creates anxiety in the first place.

The Patient Perspective Changes Everything

What makes this research valuable is its focus on understanding violence from the patient's perspective rather than only examining it from the healthcare worker's side. When you understand what's driving patients toward aggressive behavior, you can implement prevention strategies that address root causes instead of just reacting to incidents after they happen.

The study strongly supports the notion that comprehensive workplace violence prevention combines improved communication protocols, clinical considerations, patient satisfaction initiatives, anxiety management strategies, and traditional security measures. Workplace Violence cannot be solved with metal detectors alone.

The bottom line: If your workplace violence prevention program doesn't explicitly address patient anxiety, uncertainty, and satisfaction, you're not preventing violence. You're just documenting it after it occurs.

The organizations that figure this out, that train staff to recognize and reduce patient uncertainty as a violence prevention strategy, will create safer environments for everyone: staff, patients, and visitors.

Study Reference: Barutcu, C. D., & Turhan Damar, H. (2025). The relationship between violence tendency levels and intolerance of uncertainty in adults presenting to the emergency department. Journal of Emergency Nursing, 51(6), 1114-1124.

About Kim Urbanek

KIM is a leading Workplace Violence Prevention expert with over 26 years of healthcare, security, and emergency management  experience. Kim is a nationally sought-after speaker, a #1 best-selling author, and a recognized healthcare consultant. Kim is the Co-founder and Chief of Innovation and Practice of OPTICS for Healthcare, an AI driven workplace violence risk assessment and mitigation tool, designed to reduce violence and improve operations at healthcare organizations. 

About David Brake

DAVID is the Co-founder and CEO of OPTICS for Healthcare, an AI-first company dedicated to creating safer healthcare environments for staff, patients, and the public. The OPTICS platform was designed to revolutionize how healthcare organizations approach facility assessments, enabling them to conduct comprehensive current-state evaluations, generate detailed gap analyses, and develop customized workplace violence policies and action-specific operational playbooks.