VIOLENCE IN NURSING
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WORKPLACE VIOLENCE IN NURSING
Running head: WORKPLACE VIOLENCE IN NURSING
Capstone Part I: Workplace Violence in Nursing
Capstone Part I: Literature Review
Introduction to Problem
Nurses face quite a hurdle as they seek to administer the highest level of care to their patients as they carry out their duties as health caregivers. Patients can be quite an uphill task to handle but regardless of this fact, it is still required of them to cater to their patient’s every need. Nurses in hospitals among other health care facilities are at significant risk of both physical and verbal assault (Raftery & Byers, 2015). Most times, nurses tolerate these cases of violence as they consider them as part of the job. Between the years 2011 to 2013, in the United States of America alone, there were between 15000 to 20000 reported cases of workplace violence in the health care industry. At times there were serious injuries resulting from these violence cases hence some nurses were given time off work to recuperate at home.
Violence in health care has become more common than in other industries. To reduce or rather prevent cases of violence as nurses take on their duties as caregivers, there has been formed a body by the name Occupational Safety and Health Administration (OSHA) to oversee cases of violence and protect nurses from physical and verbally abusive patients. OSHA has developed and came up with resources to assist both employee and employers in establishing violence prevention programs at workplaces. Nurses are being taken through training programs that are intended to help them handle violence cases when faced with situations that may need urgent addressing before they can be reported. Additionally, OSHA is letting nurses know that there are well-laid procedures that have been put in place at their disposal to protect them from any harm they might face in their line of duty. Nurses should never be put in harm’s way more so when they seek to administer the much-needed health care to anyone (US Department of Labour, 2015).
PICOT
In nursing (P) how does an effective preventative workplace violence environment including policies and procedures (I) compared to no planned workplace violence policies and procedures in place (C) decrease physical and verbal workplace violence (O) within a 6 month timeframe (T)
Search Strategy
In order to obtain relevant literature the researcher went and searched the CINAHL EBSCO full text, PsycINFO, and PubMed. Prior to commencing the search, the researcher used the following search limiters to obtain relevant search results. The searches limited to between the years 2014 to 2019, peer-reviewed journals, and full-text option. In order to get relevant pieces of literature, the following search terminologies were used: “Workplace violence in nursing” AND “RCT or randomized control trial” this search yielded a total of 12 studies from the three databases when duplication is removed. From the search results, only one article could be used. An additional search was conducted, which employed the following search terms “violent patients or aggressive patients” AND “randomized control trial or RCT” AND “prevention.” The search yielded 9 results, whereby the researcher obtained the second article for the literature review.
Articles
Arnetz, J. E., Hamblin, L., Russell, J., Upfal, M. J., Luborsky, M., Janisse, J., & Essenmacher, L. (2017). Preventing patient-to-worker violence in hospitals: outcome of a randomized controlled intervention. Journal of occupational and environmental medicine, 59(1), 18.
Thomas, B., O’Meara, P. F., Maguire, B. J., FitzGerald, D., Begg, S. J., & Spelten, E. (2017). Organisational interventions for preventing and minimising aggression directed toward healthcare workers by patients and patient advocates. The Cochrane database of systematic reviews, 2017(5).
Level of Evidence Scale
The level of evidence (LOE) scale that will be used to critique research studies in this paper is the Rating System for the Hierarchy of Evidence by Melnyk & Fineout-Overholt (2015) with the strongest or best research evidence at the top (Level I) and the weakest research evidence at the bottom (Level VII).
· Level 1: Evidence from a systematic review or meta-analysis of all relevant randomized clinical trials (RCT).
· Level II: Evidence obtained from a well-designed RCT
· Level III: Evidence obtained from a well-designed controlled trial without randomization
· Level IV: Evidence from a well-designed case-control or cohort study
· Level V: Evidence from systematic reviews of descriptive and qualitative studies
· Level VI: Evidence from a single descriptive study (quantitative or qualitative)
· Level VII: Evidence from the opinion of authorities and/or reports of expert
committees (Melnyk & Fineout-Overholt, 2015, p. 11)
Article #1: Preventing patient-to-worker violence in hospitals: outcome of a randomized controlled intervention
Validity. The study was conducted in seven hospitals, over a period of five years. The study’s design was a randomized controlled trial that was implemented in four steps. The first steps involved standardization of violence incidents reports. The researcher conducted focus group discussion with the intention of gaining preferences on what formats to use with regards to collecting standardize information on reports of violence. The data within the report included “rates of violent events based on reported incidents; rates of violence-related injuries based on workers’ compensation claims; and descriptive characteristics of documented violent events” (p. 4). The second step of the intervention in vault developing a hazard prioritization matrix, which identified areas within the hospital that are prone to violence. Authenticity steps involved implementation of the randomized intervention. The intervention was data-driven and unit based comprising over walkthrough which was conducted during the daytime hours as well as a worksite visit during nighttime hours. Based on their crane information, the supervisors were tasked with the job of creating an action plan for reducing violence in the workplace using an adapted checklist, through the application of evidence-based administrative environmental and behavioral strategies. The fourth and final stage of the process involves monitoring and evaluation of the intervention with two years pre-intervention time and three years’ post-intervention time.
Results. The study reveals that 6 months after the intervention was implemented, and there was significantly lesser events in the intervention group compared to the control group. However, with regards to the rate of violence, they were reduced slightly in the intervention group but the change was not significant. In contrast, the rate of violence increased significantly in the control group. Additionally, with respect to violence-related injuries, there were no significant injury rates between the intervention and the control group at 6 months, 12 months, and 18 months after implementation of the intervention. Even though injury related to violence rate decreased slightly in the intervention group at 24 months, it was insignificant.
Applicability, Strengths, and Weaknesses. The strength of the study is that it is a randomized control study, which makes it easier to control other variables that may compound or influence the results, the controls implemented in study offer the researcher a clear picture of the efficacy of the intervention. The applicability of the intervention is labor-intensive due to the many steps involved. Implementing the study took 3 years, which may limit the applicability of the approach in clinical settings. Additionally, despite the laborious work, the results did not particularly impact significantly on violence-related injuries. Being that the research is tailored also undermines the control in the study. This is because each sampled department utilizes an adapted checklist, thereby somewhat limiting comparability and also increasing the variability of the study.
Article #2 Organizational interventions for preventing and minimizing aggression directed toward healthcare workers by patients and patient advocates
Validity. The study is a systematic review of randomized controlled trials which ranks the first in the hierarchy of evidence offered by (Melnyk & Fineout-Overholt, 2015). The aim of the systemic review was to Review evidence with regards to the efficacy of the interventions aimed at reducing health worker violence by patients and patients’ advocates. The systemic review divided the intervention into three categories. (1)Victim/healthcare worker, which involved undertaking measures to minimize the risk of violence or aggression through sharing information among health workers and the removal of potential weapons with strategies including assessment of risk and advance warning. (2)Vector/patient or their advocate, which involved primarily providing information to the patient as well as their advocates using instruments such as signage and advertising in order to ensure that the patient is aware of what to expect with regards to treatment and even visiting hours. (3) Social environment, which involved creating a robust environment where health workers are saved through provision of adequate staff members, not working alone, and legislative protection among others. The three categories of events were investigated before the event, during the event, and after the event.
Results. The outcome for each study that was used was placed in a table to calculate their treatment effect with the odds of risk ratios for dichotomous outcomes mean differences for the continuous outcome. The systemic reviewed insured that higher scores for continuous outcomes have the same inference with regards to the specific outcomes.
Applicability and Strengths.
The strength of the study, is that, it is wide encompassing and only reviews random controlled trials which increases the rigor of the study. The study has also outlined systemically the steps if followed in reviewing the literature, which establishes reliability of the methodology used. Due to the fact that the study covers a wide scope, its applicability is also wide particularly in determining which of the three approaches to implementing in order to reduce patient violence in health workers. Additionally, it is important to note that, the review is not limited to the nursing field but generalizes all health workers.
Conclusions from Literature Review
Evidence from article 1 (Arnetz, et al., 2017) reveals that for an intervention to be successful in preventing workplace violence it requires it to be tailored to the specific context the nurse is working within. This involves whether it’s daytime or nighttime, or whether it is in a particular department, which enables the supervisor to tailor an action plan based on the risks identified in that particular department. With regards to article 2 (Thomas et al., 2017) interventions for reducing workplace violence are scoped widely for health workers. The interventions not only involve reducing violence between the health worker and the patient but also using vector approaches as well as improving on the social environment.
Capstone Part 2: Education and Evaluation Plan
Introduction
The aim of this paper is to highlight the aspect of nursing violence in the workplaces, since it is quoted as leading cause of frustration to nurses and consequently, develops a devastating effect to nursing turnover and shortage (Magnavita & Heponiemi, 2014). To increase retaining more nurses within the line of work and improve fulfilment, healthcare establishments need to sustain a nontoxic atmosphere where healthcare providers can offer quality care to patients. Research studies concerning workplace violence has been existing for more than (thirty) years, but few studies on how to deal with workplace violent conditions has been conducted (Magnavita & Heponiemi, 2014). The necessity for nurses is ever growing since more nurses are approaching retirement.
Analysis
In order to avert the persistent lack of nurses in healthcare organizations or hospitals, it is vital to guide and nurture nurses within the nursing profession so that they are able to care for our individuals who require and seek healthcare (Magnavita & Heponiemi, 2014). Workplace violence among nurses is mentioned as the leading cause of frustration, particularly, among new nurses. Normally, frustration at work results to high turnover at the administrative level and results to new nurses distress whereby, others to opt or quit the profession (Magnavita & Heponiemi, 2014). Horizontal violence is a word used to explain or describe inter-group hostility. Horizontal violence is negative treatment or behavior between group members or individuals. However, the term is substitutable in regards to lateral violence (Magnavita & Heponiemi, 2014).
This is to say, horizontal violence is articulated as harassment, which that can be psychologically harmful and comprises of intimidation, verbal abuse, threats, excessive criticism, humiliation, innuendos, denial of access to opportunities, exclusion, discouragement, disinterest as well as withholding of information between individuals or groups of people (Magnavita & Heponiemi, 2014).
The target audience for this paper are the new nurses and top level management. Over the years, nurses have been exposed to physical and verbal attacks from physicians and colleagues alike (Magnavita & Heponiemi, 2014). In this case, workplace violence has been a continuing progression and has rendered many nurses confounded as to the reason for its occurrence and many are not prepared to deal with the conflict. A number of research has indicated that physical and verbal abuse and the intention of a nurse to quit the organization are substantially related (Magnavita & Heponiemi, 2014). Also, new nurses are the leading victims of exploitation from other coworkers and are the least studied nursing population with respect to violence in the workplace.
Most of these research studies have been performed both internationally and nationally to assess and examine violence or negative interactions against nurses (Magnavita & Heponiemi, 2014). Violence directed to nurses are well examined such as physician to nurse, patient to nurse as well as patient’s family to nurse, nonetheless more education programs and awareness regarding lateral as well horizontal violence are required. Valuation of workplace violence occurrence among new nurses including the degree of anguish it inflicts on nursing profession, and guidelines on effective approaches against lateral abuse within healthcare establishments are needed (Magnavita & Heponiemi, 2014).
Workplace violence offers a dangerous setting for nurses to execute medical care that such bodies like The Joint Commission, instructed that all establishments develop and implement methods and practices to decrease workplace violence and offer a culture of proficient or professional code of conduct and effective communication (Magnavita & Heponiemi, 2014). In addition, it is important that nurses become aware of horizontal violence and are offered tools in the long run eliminate the damaging issue by employing strategies as indicated in Appendix A.
Additional studies have concluded that victims of workplace violence exhibit similar symptoms of patients with post-traumatic stress disorder, stating that horizontal violence is capable of causing physical and psychological effects one and the same with PTSD such as constant anxiety, hyper-arousal, flashback as well as avoidance of the traumatizing experiences (Magnavita & Heponiemi, 2014). The occurrence of workplace violent can influence or impact a nurse with destructive psychological recollections so that she or he may be incapable to fully function as an effective and safe nurse
Many of the studies studied had shared sentiments in that interpersonal and communication and conflicts, whereby, violence between supervisors and medical staff were the most worrying (Magnavita & Heponiemi, 2014). Verbal violence may be considerably costly to the organization as well as to the patient and the nurse. Nurse to nurse oral violence has a particularly debilitating effect on the new nurse including her job or on his satisfaction including the general sense of well-being at the place of work (Magnavita & Heponiemi, 2014).
Conclusion
The hypothetical framework for experienced and new nurses, for the educational program on describing, identification and approaches for eradication of workplace violence is the theory of empowerment. In essence, central points of the empowerment or enabling theory are defined as control and participation for organization and individuals. In addition, the empowerment theory integrates a active approach towards life issues, awareness of control as well as a critical consideration of the sociopolitical situations for purposes of accomplishing goal achievement. Fruitful control and mastery over circumstances in stressful situations can start taking place at the individual level since, such a strategy has the potential of affecting both the community and organization. Nonetheless, it is worth to remark that community and organizational enablement is not merely attained by having an assemblage of empowered persons, but through different ranks of analysis.
References
Arnetz, J. E., Hamblin, L., Russell, J., Upfal, M. J., Luborsky, M., Janisse, J., & Essenmacher, L. (2017). Preventing patient-to-worker violence in hospitals: outcome of a randomized controlled intervention. Journal of occupational and environmental medicine, 59(1), 18.
Magnavita, N., & Heponiemi, T. (2014). Workplace Violence Against Nursing Students and Nurses: An Italian Experience. Journal of Nursing Scholarship, 43(2), 203-210. doi:10.1111/j.1547-5069.2011.01392.x
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (3rd ed.). Philadelphia, P.A.: Wolters Kluwer/Lippincott, Williams & Wilkins.
Thomas, B., O’Meara, P. F., Maguire, B. J., FitzGerald, D., Begg, S. J., & Spelten, E. (2017). Organisational interventions for preventing and minimising aggression directed toward healthcare workers by patients and patient advocates. The Cochrane database of systematic reviews, 2017(5).
Appendix A: Teaching Plan Table
Learning Objectives
Outline
Time
Teaching Strategy
Evaluation Method
Reference
After the presentation, the nursing students (NP) will be able to describe statistics related to the problem of workplace violence and define violence such as verbal abuse, excessive criticism as well as intimidation in nursing.
1. Horizontal violence among nurses is mentioned as the forefront of frustration among new nurses.
2. Research studies concerning horizontal violence has been existing for more than (thirty) years.
15 minutes
1. Power point presentation
2. Small group discussion.
Quiz
Games
(Magnavita & Heponiemi, 2014)
2.
After viewing the video-tape, the nurses will define the following interventions to combat
Violence.
Nursing interventions that can be used to combat workplace violence include Effective
Communication,
Maintaining
Professional code of
Conduct as well as
Encouraging ethical
Practices.
10 Minutes
Small Group Discussion.
Quiz
(Magnavita & Heponiemi, 2014)
After the presentation, the nurses will relate the recommendations by The Joint Commission to the policies or practices at their facilities.
4
Guideline Recommendation
Effective communication.
b)
Developing Ethical Standards.
c)
Enhancing Interpersonal Relationship.
5 minutes.
Role Play
Game
(Magnavita & Heponiemi, 2014)
New nurses will be able to explore different methods of dealing with and expressing their feelings. Also, they will be required to fill a risk assessment quiz to establish their risk levels.
Effective communication.
15 minutes.
Role Play
Quiz
Capstone Presentation and Evaluation of Effectiveness
Appendix B: Educational Materials
Appendix C: Evaluation Method
