Violence in Nursing

Violence in Nursing

Carl Stuart

Stuart Medical Series.

Abstract

       Workplace violence is an anti-social phenomenon that involves misuse or abuse of power, and its detrimental effects have been documented by governmental institutions and other relevant professional bodies. As such, it is a recognized occupational hazard in the nursing profession. Nurses do play a central role in the healthcare team, and they also interact extensively with their clients and the clients’ relatives and friends, and they are therefore vulnerable to violence directed against them by their patients or the patient’s relatives and friends. This paper aims to discuss the various types of workplace violence as they relate to the nursing profession in regards to why the nurses are prone to violence, the participants in such violent actions and the effects that such violence has on the person abused. The paper also discusses how violence in nursing impacts the nursing practices and the provision of quality healthcare.  The implications of such violence in future nursing practice are also discussed in the paper. Finally, the healthcare policies are discussed in relation to violence in nursing.

Introduction.

Violence refers to the deliberate use of force (mainly physical force) to harm, or threaten to harm, another person or groups of persons. Workplace violence is an anti-social phenomenon that involves misuse or abuse of power, and its detrimental effects have been documented by governmental institution and other relevant professional groups (Harrigan & Dakin, n.d). These detrimental effects include employee disunity, depriving the employees of a secure workplace, and workplace maldevelopment. There is a high probability of workplace violence in institutions, commercial entities and corporations that employee a large number of employees or commercial entities that provide services to a many consumers (DHSA, 2005). In 1999, McKoy and Smith-Pittman stated that the victims of workplace violence in the United States numbered more than 20 million employees. More than 60% of these cases were instances of lateral violence (Smith-Pittman & McKoy, 1999).

The healthcare sector is a diverse industry that employs many people. The employees are expected to form a healthcare team that will deliver quality services to their clients. Nurses do play a central role in this team, and as such they do interact with their clients and the clients’ relatives and friends regularly. This places them in a vulnerable position with regard to violence directed against them by their patients or the patient’s relatives and friends. Workplace violence is a recognized occupational hazard in the nursing profession. Usually, the violence that is directed towards nurses emanates from three main sources: clients, fellow nurses (and in some instances, other healthcare professions) and the healthcare administration (DHSA, 2005). Patients suffering from psychiatric conditions or patients who have been exposed to prolonged psychological and physical discomforts have the highest probability of initiating violence against nurses who attend to them. Moreover, clients who feel that they have received inadequate or inappropriate services within a healthcare facility are likely to be violent towards the nurses. Lateral violence in nursing refers to violence directed to a nurse by a fellow nurse (Harrigan & Dakin, n.d).

In this paper, the issue of violence in nursing has been chosen and discussed due to its negative effects on the provision of healthcare services to patients. This paper aims to discuss the various types of workplace violence as they relate to the nursing profession, why the nurses are prone to violence, the participants in such violent actions and the effects that such violence has on the person abused. The paper also discusses how violence in nursing impacts on nursing practices and quality healthcare provision.  The implications of such violence in future nursing practice are also discussed in the paper. Finally, the healthcare policies are discussed in relation to violence in nursing.

Types of violence.

There are different types of workplace violence. In nursing practice, the three most common types of workplace violence are physical violence, emotional abuse and sexual abuse (or harassment). Incidences of both lateral and horizontal violence are also ever-present (Harrigan & Dakin, n.d). Norris in 2010 defined lateral violence as  the acts of humiliating, threatening or even inflicting actual physical, emotional or mental harm onto a member or members of a peer group using various tactics such as withholding information, using condescending language, belittling; and/or displaying impatience, rudeness or even throwing temper tantrums. Horizontal violence in the clinical setting encompasses acts of bullying directed towards the nurse by fellow nurses whereby the abuser initiates unnecessary arguments and offers undue criticisms to the actions of the abused nurse with the intention of undermining or sabotaging the professional successes of the abused nurse (Harrigan & Dakin, n.d). Research has shown that nurses do report the following types of workplace violence: verbal aggression, property damage, stalking, sexual harassment and abuse from co-workers and patients. Nurses have reported being grabbed inappropriately, pushed, pinched, kicked, scratched, stabbed, bitten, urinated and having their hair forcefully and violently pulled. There are also instances where nurses have been spat on, urinated on and even defecated upon by the patients that they were attending to. Another common phenomenon in the hospital is the bullying of recent graduand nurses by the older nurses. However, this bullying has been attributed to the fact that the older nurses are intransigent, obdurate and unwilling to accept changes that the recently employed nursing graduands hope to effect (DHSA, 2005).

The nurses are at risk of workplace violence due to the factors explained hereafter. To begin with, it is well known and acknowledged that nursing is an understaffed career where the nurses are exposed to high stress levels due to the nature of their work, and the overwhelming volume of the workload. This fact is compounded by inappropriate distribution of duties and tasks to the few available nurses and this leads to conflicts, arguments and even fights among the nurses. Secondly, nurses do tend to patients who are afflicted by mental illnesses, and it has been documented that such patients have the highest probability of attacking nurses. This can be attributed to the fact that these patients have impairment in their reality testing capacity and this inhibits them from evaluating the appropriateness of their actions. Thirdly, nurses also care for patients with chronic diseases. Such patients have been exposed to prolonged periods of psychological, physical and emotional stress thus making them irritable and more prone to commit violent acts against their nurses. Sometimes, the nurses also take care of patients undergoing palliative management, and in this instances, the stressed family members, relatives and friends of the patient are likely to be violent to the nurse, especially if they perceive that their patient is receiving, inadequate, inappropriate or substandard treatment. Moreover, some disgruntled patients do incite their visiting relatives and family members to be violent to the attending nurses. Additionally, nurses are also expected to attend to criminals who have been injured, and such criminals are known to be violent to the nurses as they do not want to answer questions or adhere to the instructions given by the nurse. Some of these criminals do even beat the nurses in order to create an opportunity for them to escape from the law enforcers. Finally, nurses do interact with their peers and other members of the healthcare team, and this predisposes them to abuse by doctors, surgeons, midwifes and physiotherapists (DHSA, 2005).

Violence directed to nurses by the healthcare systems is exemplified by facts such as devaluing the work (or experience) of the nurse, refusing to promote the nurse or increase his/her pay, withholding support from the nurse, limiting the nurse’s right to opinion and free speech, exhibiting elitist attitude towards the nurse, ignoring the concerns of the nurse, issuing immoderate punishment for minor mistakes that the nurse has done; and also preventing the nurse from participating (or seeking membership) in professional organizations (Hastie, 2001).

Studies done concerning occupational hazards have shown that not all instances of violence on nurses are reported. There are several explanations for this observation as shown hereafter. First of all, most male nursed are unlikely to report instances of sexual abuse due to embarrassment. They are also unlikely to report instance of physical abuse due to cultural considerations which demand that a man should never display his weaknesses to the public. Secondly, some abuses have occurred habitually in the workplace to the point that such abuses are considered to be normal. Thirdly, some nurses do not know that they are being abused since they lack sufficient knowledge regarding their rights and obligations in the workplace. Such nurses are also unable to report the abuses as they do not know where to report, and also how to report the abuses. They may also be discouraged from reporting due to an overburdening bureaucracy or bureaucratic protocols and the associated paperwork. Some nurses also tend to underestimate the significance or gravity of the abuse, and they are thus likely to avoid filing a report about abuses that they consider to be trivial. Finally, the society lenient attitude towards violence as popularized by the mass media has significantly altered the way nurses and other members of the healthcare team react to instances of violence (DHSA, 2005).

Effects of workplace violence.

Workplace violence does affect the abused nurse in several ways as explained hereafter. To begin with, such violence lowers the self-esteem of the abused person and this leads to the abused nurse to experience a state of free-floating anxiety. Secondly, violence does lead to sleep disorders as the abused person attempts to understand and adjust to the new hostile workplace environment. Such sleep disorders lead to mental fatigue and this makes the abused nurse to be emotionally unstable and demotivated.  If the violence is overbearing and unbearable, the abused nurse will experience relative intolerance to sensory stimulation, and will also be oversensitive to innocuous comments and insinuations (Hastie, 2001).

Change in response patterns that are congruent to an evolving personality change may also be observed in the abused nurse. Other effects of workplace violence include eating disorders, hypertension, apathy, low morale, nervous breakdown, disconnectedness, depression, suicide (attempted or successful), impairement of personal relationships, and removal of the abused nurse from the workplace both psychologically and physically through stress leave, sick leave or even resignation (Hastie, 2001).

Workplace violence, nursing practice and the provision of healthcare services.

Violence to nurses do negatively affects the provision of healthcare services to the patients in the following ways. To begin with, violence to a nurse leads the abused nurse to be violent to the patients under is/her care and this leads to instances of miscommunication and inadequate care being given to the client. This in turn leads to an overall poor health outcome and a poor prognosis of acute diseases. The patient may inform his/her relatives and family members bout the improper nurse-patient relations and the inadequate services provided by the facility; and this ultimately leads to the healthcare facility losing clients due to a bad public reputation (Harrigan & Dakin, n.d).

Secondly, the abused may experience difficulty in maintaining a professional relationship with other members of the healthcare team, and this has a negative impact on the treatment and management of patients. If the abused nurse is a theatre nurse, then there is a high possibility of the surgical operations being bungled or being done inappropriately (Harrigan & Dakin, n.d).

Thirdly, violence and incessant conflict among the nurses may lead to an incapacitation of the nursing department of the hospital thus forcing the hospital to shutdown. For this reason, it is appropriate that violence against nurses should be averted and mitigated; and if such violence occurs, it should be punished swiftly and moderately (Harrigan & Dakin, n.d).

Finally, in the psychiatric institution, violence against the nurses may lead the nurses to neglect their patients, and this exposes the patients to harm. Moreover, if the nurses refuse to administer the prescribed drugs to a maniac or overly depressed patient, the patient may commit suicide. Thus, violence directed towards nurses by psychiatric patients may indirectly lead to the death of these patients (Harrigan & Dakin, n.d).

Violence and the future of nursing practice.

Violence in nursing is recognized as a major factor that contributes to the lowering of the standards of healthcare provisions, and as such healthcare accreditation organizations have laid down a set of guidelines and eligibility criteria that are used to evaluate the eligibility of hospitals seeking accreditation. The eligibility criteria include a provision that the healthcare facility should formulate and enforce policies that identify, prevent and address issues related to workplace violence. The criteria also include a provision for the establishment of whistle-blower protection systems that would protect a person who reported an instance on abuse or violence against retribution. Finally, there is an eligibility criterion that requires the healthcare facility to compensate the nurses as per the legislative requirements. This ensures that the nurse is not abused by the hospital administration. The above eligibility criteria would force healthcare facilities to take the issue of violence in the workplace seriously, and thus formulate and enforce guidelines, procedures and policies that would ensure that the rights of the nurse is respected. Since it is mandatory that all healthcare facilities should be accredited, it thus follows that the future of nursing practice is likely to be experience a drastic reduction in instances of violence in nursing (Harrigan & Dakin, n.d).

Healthcare policies and violence in nursing.

The current healthcare policies require employers to adhere to the legislative requirements that require them to provide a secure and safe workplace for their employees, and this includes an environment free from workplace violence. Moreover, the policies require the employer to identify and de-escalate horizontal and lateral violence among nurses. The policies have also laid down rules regulating the professional conduct of nurses in the workplace, and some of the rules require the nurses to create and sustain a violence-free workplace. Finally, the policies require the patients to behave respectfully to nurse and also observe the basic rules governing nurse-patient etiquette (Harrigan & Dakin, n.d).

Summary.

Workplace violence is an anti-social phenomenon that involves misuse or abuse of power, and its detrimental effects have been documented by governmental institution and other relevant professional groups. In the hospital setting, the violence that is directed towards nurses emanates from three main sources: clients, fellow nurses and the healthcare administration. In nursing practice, the three most common types of workplace violence are physical violence, emotional abuse and sexual abuse (or harassment). Incidences of both lateral and horizontal violence are also ever-present. Research has shown that nurses do report the following types of workplace violence: verbal aggression, property damage, stalking, sexual harassment and abuse from co-workers and patients. However, studies done concerning occupational hazards have shown that not all instances of violence on nurses are reported. Fortunately, the future of nursing practice is likely to be experience a drastic reduction in instances of violence in nursing due to the policies laid down by the accreditation organizations.

References.

Department of Human Services of Australia (DHSA). (2005). Occupational violence in nursing: An analysis of the phenomenon of code grey/black events in four Victorian hospitals. Melbourne: Policy and Strategic Projects Division.

Norris, T. L. (2010). Lateral violence: Is nursing at risk. Tennessee Nurse, 73(2), 6-7.

Hastie, C. R. (2001). Horizontal violence in the workplace. Birth International.

Harrigan, R., & Dakin, S. National Overview of Violence in the Workplace.

Smith-Pittman, M. H. & McKoy, Y. D. (1999). Workplace violence in healthcare

environments. Nursing Forum 34(3), 5-13.