NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay

NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay Workplace violence against nurses is a major challenge for healthcare leaders. Common types of violence such as physical harm, sexual abuse, aggression, mobbing and bullying can occur from patients, family and co-workers. What impact does workplace violence have on nurses, other clinical staff and the organization as a whole? Be specific and provide rationale How is workplace violence addressed in your organization, i.e. policies, protocols, training. Be specific. Is it sufficient? What else could be done? What are the legal and ethical implications for the nurse leader if workplace violence occurs on their unit(s)? NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so, others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes. No direct quotes are allowed in the discussion board posts. References: Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references. Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response. nrse_4580_m5_im_alkorashy_et_al_2016_international_nursing_review__1_.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Original Article Workplace violence against nursing staff in a Saudi university hospital Hanan A. Ezzat Alkorashy1,2 Moalad3 RN, MScN BScN, MSc, PhD & Fawziah Bakheet Al 1 Assistant Professor, Nursing Administration Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt 2 Assistant Professor, Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, KSA 3 Director of Nursing Services, King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia ALKORASHY H.A.E. & AL MOALAD F.B. (2016) Workplace violence against nursing staff in a Saudi university hospital. International Nursing Review 63, 226–232 Background: Violence against nurses is a major challenge for healthcare administrators. It is gaining more attention because it has a negative impact on nurses, the quality of health care and health organization. Common types of violence include physical harassment, sexual abuse, aggression, mobbing and bullying. Patients, their relatives and co-workers are considered the main perpetrators. Aim: To determine the prevalence rate of workplace violence against nursing professionals in a university hospital in Riyadh, Saudi Arabia, most frequent type and perpetrators as well as the contributing factors. Methods: This quantitative cross-sectional study adapted a survey questionnaire from the Massachusetts Nurses Association Survey on Workplace Violence/Abuse to collect data from a quota sample of 370 nursing personnel. Results: Almost half of the participants had experienced violence in the professional setting during the 12 months prior to the study. The majority of subjects perceived workplace violence as verbal abuse. Nearly all nursing professionals identified patients as the leading cause. Slightly more than half mentioned understaffing, misunderstandings, long waits for service and lack of staff training and policies for preventing crisis as contributing factors. Conclusion and Implications for Nursing and Health Policy: The prevalence rate is extremely high among nurses in the targeted Saudi university hospital. Saudi health as well as university hospitals’ administration and policy makers should adopt and introduce a ‘zero tolerance policy’, set standards and develop practical measures for preventing the incidence and for controlling the prevalence of violence against nurses. Besides, healthcare organizations, particularly hospitals, can fulfil their obligations to provide both staff and patients with more secure environment. Further research on the topic is needed. Keywords: Hospitals, Nursing staff, Saudi Arabia, Teaching hospital, Workplace violence, mobbing, bullying, harrassment, abuse, violence Correspondence address: Hanan A. Ezzat Alkorashy, Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia; Nursing Administration Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt; Tel: +966553121296; Fax: +966118050835; E-mails: halkorashy@ksu.edu.sa; hanan_alkorashy@yahoo.com. Conflict of interest No conflict of interest has been declared by the authors. Funding This research project was supported by a grant #GSS-212-668 from the “Research Center of the College of Nursing”, Deanship of Scientific Research, King Saud University. © 2016 International Council of Nurses 226 Workplace violence against nursing staff Introduction Workplace violence (WPV) is a serious organizational issue in all countries and is strongly linked to inappropriate healthcare outcomes. According to the World Health Organization (WHO 2002), WPV refers to occupational settings or incidents wherein workers are threatened, abused or assaulted. Verbal harassment, abuse, threats and bullying are common examples of WPV. Subtle behaviours and coercion are also considered types of WPV (Dionisi et al. 2012, p. 398). WPV against nursing professionals continues to increase within healthcare organizations (Kuehn 2010). The International Council of Nurses (ICN) acknowledged WPV as a significant issue in nursing and requested that attention be given to clinical issues and competence in dealing with violence (Franz 2010). Nursing professionals are the leading victims of WPV worldwide.NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay Verbal misconduct and threats by patients and other staff members against new nursing professionals are common (Teferralikassa & Jira 2015). Teaching hospitals in Saudi Arabia, as in many other countries, serve a large number of patients and provide patients with free services; therefore, many patients seek medical and nursing care. However, the presence of medical students and medical, nursing and paramedical staff lead to difficult working conditions and hospital overcrowding and result in nurses’ overload, stress and lack of interest in work (Teferralikassa & Jira 2015). Moreover, studies have shown that specific features of the workplace site such as poor working conditions, poor lighting, low security, a high number of hours worked and poor staffing are known risk factors for WPV (AbuAlRub & Khawaldeh 2014; Banerjee 2008). Additionally, nurses’ attitudes and witnessing previous workplace assaults have been reported as risk factors contributing to future assaults (Spector et al. 2014). Concomitantly, no effective prevention protocol or official reporting method about violence in Saudi healthcare settings is available. Literature review International studies have reported high prevalence rates of WPV against nurses: ranging from 6% up to 74% (Esmaeilpour et al. 2011; Kennedy & Julie 2013; Pai & Lee 2011; Speroni 2014; Talas et al. 2011). For the regional prevalence, several Arab studies have shown a rapid increase in the prevalence of WPV against nurses and ranged between 7% and 91.6% (Abbas & Selim 2011; AbuAlRub & Khawaldeh 2014; Deeb 2003; Taher 2010). Concomitantly, in the Kingdom of Saudi Arabia, the situation is comparable (Algwaiz & Alghanim 2012; Almalki et al. 2012). © 2016 International Council of Nurses 227 An enhanced understanding of the risk factors of WPV will help identify strategies to prevent WPV (Esmaeilpour et al. 2011). The main factors influencing WPV include gender, age, education and previous experiences (Taher 2010). Patients, relatives, healthcare workers, and visitors are common sources of WPV (Angland et al. 2014; Esmaeilpour et al. 2011). Communication barriers can also result in an increased risk of WPV (Shafipour et al. 2014). In this context, Shafipour et al. (2014) stated that effective and appropriate communication is necessary between nurses and patients for the delivery of health care. Impaired communication will result in the patients’ disappointment and anger. The negative consequences of widespread WPV significantly affect the delivery of healthcare services, reducing the quality of care and increasing the number of healthcare workers leaving the profession (World Health Organization (WHO) 2002). Aims of the study This study aimed to determine the prevalence rate of WPV against nurses in a Saudi university hospital and to identify the common types, perpetrators and precipitating factors of WPV, as well as its impact on nurses. Methods Setting and Participants This cross-sectional study was conducted in an 860-bed university hospital in Riyadh City, Saudi Arabia. It used a quota sample of bedside nurses (n = 425) and all head nurses and charge nurses (n = 75). From the accessible population (n = 1232), the sample size was calculated using the G*power 3.0 program. The number of subjects needed to achieve an effect size of 0.3 (medium), a level of significance (a) of 0.05, and a test power (1 b) of 0.95 was 293. As the inclusion of participants was not random (convenience instead), the sample was further increased by 15% to account for contingencies such as non-response and/or potential drop-outs, bringing the final sample size to 500 nurses. The inclusion criteria were professional nurses working in all/some of the shifts, those in technical or administrative positions, those with at least 1 year of experience in the selected setting, and those who were willing to participate in the study. Study instrument This study adapted the survey questionnaire from the Massachusetts Nurses Association Survey on Workplace Violence/ Abuse, with a permission. The questionnaire was developed in English language, validated and used in a previous study conducted by the Massachusetts Nurses Association Congress 228 H. A. E. Alkorashy and F. B. Al Moalad on Health and Safety and Workplace Violence and Abuse Prevention (MNA 2008). NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay The questionnaire contains 40 structured multiple-choice questions related to the prevalence of WPV, forms and perpetrators as well as precipitating factors for WPV. As the official language in the work setting is the English language, the decision was no translation was required and the questionnaire was used in its original language. A pilot study on 30 participants had been conducted. Two words were changed: “Union representative” in question 13, was changed to “hospital security office” because there is no union in KSA and in question 20, “Employer” was changed to “hospital” and “tolerating undesirable behaviour, such as violence” instead of “zero tolerance policy” because the latter was not clear for the most of the subjects in the pilot study. The reliability for the tool was determined by Cronbach’s alpha (a = 0.7615). Data collection The self-administered questionnaires were distributed to the participants after receiving approval to conduct the study from the research/ethical committee and the administration of the university hospital. The data were collected from March to May 2011. Perceptions of WPV by violence experience and job category The results of this study revealed that more nurses who had experienced WPV perceived it as verbal abuse (v2 = 27.838, P < 0.001), and consider it as a serious problem (v2 = 107.484, P < 0.001) as compared with those who had not experienced WPV. On the other hand, more nurses who had no experience with WPV perceived it as physical attacks compared with those who had experienced WPV (v2 = 4.885, P = 0.027) (Table 1). Perpetrators and forms of violence Participants who had experienced WPV in the 12 months prior to data collection (n = 175) were asked to indicate the form and source of the violence. From all violence incidents (n = 1103), all the participants identified patients as the main perpetrators (f = 204), followed by the patients’ relatives (f = 195). Verbal abuse was the most frequently reported forms of violence 435 (38.5%) exhibited by the 99 (56%) physicians, 89 (50.9%) patients and 82 (47.0%) patients’ relatives. Followed by verbal or written threats, 289 (27.4%); and threatening behaviours, 226 (19.6%) (Table 2). Precipitating factors of WPV Data analysis The data were analysed using descriptive and inferential statistics. Spearman’s chi-square test had been used to compare variables across groups and to investigate the relationship of selected demographic characteristics with the perceptions of WPV. Several factors contribute to the emergence of WPV against nurses. These include organizational, individual and situational Table 1 Variance between the perceptions of WPV of those with and without WPV experience Perception of nurses Ethical considerations The content and method of this study was approved by the college of nursing administration, in the target Saudi university, the research centre (IRB# 10-2576) and the ethics committee (EC# 14158) of the target hospital setting prior to study conduction. The participants signed an informed consent form after being informed about their information anonymity and voluntary participation. Results From the 500 distributed questionnaires, 404 were returned, resulting in a response rate of 80.8%. Among the returned questionnaires, 34 were excluded due to insufficient answers or missing data. Thus, 370 questionnaires (74%) were used for analysis. The majority of participants were staff nurses (80.3%) and worked 8-h shifts (54.2%). Moreover, most of the nurse participants were female (93.2%), aged 31–39 (35.8%) or 26–30 (24.8%), married (70%), Asian (83.9%) and held a diploma degree (61.6%). © 2016 International Council of Nurses Yes (n = 175) Definition Verbal abuse 147 (83.9) Verbal/written threats 117 (66.8) Threatening behaviour 97 (55.7) Physical attack 82 (46.9) Sexual harassment 55 (31.6) Sexual assault 41 (23.6) All of the above 36 (20.7) Seriousness of violence problem Very serious 25 (14.0) Somewhat serious 56 (32.1) Not sure 17 (9.6) Not too serious 57 (32.6) Not at all serious 21 (11.7) *Significant at P < 0.05. v2 (P) Suffered violence experience No (n = 195) 133 121 103 106 73 57 46 (68.15) (62.3) (53.0) (54.6) (37.3) (29.2) (23.4) 27.838* (<0.001) 1.858 (0.173) 0.594 (0.441) 4.885* (0.027) 2.888 (0.089) 3.270 (0.071) 2.421 (0.075) 4 28 42 68 52 (2.1) (14.6) (21.5) (35.0) (26.9) 107.484* (<0.001) Workplace violence against nursing staff 229 Table 2 Frequency of exposure to forms of violence from different perpetrators as reported by nurses who experienced violence (n = 175) Form of violence Verbal abuse Verbal/written threats Threatening behaviour Physical attack Sexual harassment Sexual assault Total* Perpetrators f (%) Patient Patient’s Relative Physician Supervisor Nurse Others TotalNRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay † 89 42 30 34 8 1 82 46 52 9 6 0 99 39 33 0 6 0 64 69 32 0 5 5 83 40 26 10 16 0 18 (10) 53 (30) 53 (30) 0 (0.0) 44 (25) 9 (5) 177 435 (38.5) 289 (27.4) 226 (19.6) 53 (5.03) 85 (8.1) 15 (1.4) 1103‡ (50.9) (23.8) (17.2) (19.6) (4.7) (0.8) 204 (47.0) (26.1) (29.7) (5.2) (3.4) (0.0) 195 (56) (22.0) (18.6) (0.0) (3.4) (0.0) 177 (36.4) (39.4) (18.2) (0.0) (3.0) (3.0) 175 (47.2) (22.6) (15.1) (5.7) (9.4) (0.0) 175 *Exposure to specific perpetrator. †Exposure to specific form of violence. ‡Total number of violence incidents of all forms from all perpetrators. factors. The findings indicated that understaffing, particularly during meal times and visiting hours, was the most frequently reported factor (53.6%) by the participants. Moreover, “misunderstandings” was cited due to the communication barrier among nurses and patients (54.4%) and “working directly with volatile individuals” (42.5%). About a third (32.6%) of the participants reported “long waits for service” and a similar proportion (31.9%) cited “inadequate security” as factors leading to WPV. “Lack of staff training and policies for preventing crisis” was the only organizational factor that showed a statistically significant difference between groups (v2 = 5.375, P = 0.020); it was reported more frequently by staff nurses (24.9%) than by nurse managers (12.3%) (Table 3). Table 3 Precipitating factors of WPV reported by participants according to job category (n = 370) Factors Organizational factors Working when understaffed Poor environmental design Lack of staff training and policies Overcrowded, uncomfortable waiting rooms Unrestricted movement of the public Poorly lit corridors, rooms, parking lots Individual factors Working directly with volatile people Working alone Drug and alcohol abuse Personal problem of co-worker Misunderstanding Situational factors Inadequate security Concern of patients Access to firearms Transporting patients Long waits for service *Significant at P < 0.05. © 2016 International Council of Nurses Nurse Mgrs (n = 73) Staff Nurses (n = 297) Total v2 (P) 35 3 9 5 6 1 (47.9) (4.1) (12.3) (6.8) (8.2) (1.4) 163 35 74 38 20 10 (55.0) (11.8) (24.9) (12.8) (6.7) (3.2) 198 38 83 43 26 11 (53.6) (10.4) (22.5) (11.7) (7.0) (2.8) 1.169 3.790 5.375* 2.021 0.207 0.712 (0.280) (0.052) (0.020) (0.155) (0.649) (0.399) 26 13 12 10 40 (35.6) (17.8) (16.4) (13.7) (54.8) 131 47 40 59 161 (44.1) (15.7) (13.4) (19.8) (54.3) 164 62 54 72 210 (42.5) (16.1) (14.0) (18.7) (54.4) 1.739 0.204 0.449 1.456 0.006 (0.187) (0.652) (0.503) (0.228) (0.941) 30 15 1 12 22 (41.1) (20.5) (1.4) (16.4) (30.1) 88 64 3 41 99 (29.7) (21.7) (1.0) (13.7) (33.2) 118 79 4 53 121 (31.9) (21.5) (1.0) (14.2) (32.6) 3.533 0.049 0.098 0.353 0.257 (0.060) (0.826) (0.755) (0.552) (0.612) 230 H. A. E. Alkorashy and F. B. Al Moalad Discussion The findings of this study revealed that nurses’ perceived level of WPV was lower than that of previous studies. Various factors that may trigger violent incidents against nurses in hospital settings were identified. Jordan et al. (2010) argued that nurses’ perception of WPV is subjective; therefore, it may be interpreted in different ways. Howard (2011) found that participants perceived some acts as more representative of WPV than others. This is consistent with the current study findings, which showed the participants’ varied perceptions of the definition of WPV and their lack of understanding of the term. Almost all the nurses regarded WPV as verbal abuse and verbal/written threats. In the present study, nurses who had experienced violence defined it as verbal abuse, while those who had not experienced violence perceived it as a physical attack. Most participants did not perceive violence as a serious problem in their work setting. NRSE4580 Ohio What Impact Does Workplace Violence Have on Nurses Essay Thus, nurses are not fully aware of the violence occurring around them. This result is consistent with that of Mueller & Tschan (2011), who found that nurses usually perceived violent incidents by the patients as less serious than violent incidents by the employees. They also found that workers in healthcare institutions often bear with the patients’ violent behaviours in clinical settings. In the present study, the participants who had experienced a violent incident were asked about its causes. The most commonly reported causes were miscommunication and anger. Miscommunication was a frequently cited cause because most of the participants were non-Arab nurses and most patients and their families did not speak English, which created a communication barrier. Additionally, interpersonal communication between the staff members was occasionally ineffective because the nurses belonged to different nationalities and had different cultural backgrounds, principles, values, attitudes and experiences. This cultural diversity can increase the risk of interpersonal conflict, leading to violence. Hahn (2010) also found that impaired verbal communication about therapeutic planning is associated with an increased risk of WPV. Nursing professionals should know that the patients and their visitors could show inappropriate emotions, aggressiveness and violent behaviour at the time of treatment. These factors are the leading causes of WPV (Bowie et al. 2002). Taher (2010) suggested that thorough and respectful communication with patients and their companions must be initiated in the early stages of treatment. Communication with patients should include clarifying expectations and explaining standard procedures, which would lessen frustrating situations. Nurses are one of the professional groups who are at risk of WPV (Gates et al. 2011). In the current study, approxi- © 2016 International Council of Nurses mately half of the subjects suffered from at least one form of WPV in the year prior to data collection. This result is consistent with those of many studies conducted in Arab and foreign countries. The incidence rate of WPV in these studies ranged from 50% to 86% (Almalki et al. 2012; Lim et al. 2010; Newman et al. 2011). The findings of this study revealed that patients and their families were the most frequent perpetrators of violence against nurses. This finding is inconsistent with the findings of other studies examining WPV in healthcare settings (Al-Omari 2015; Cashmore 2012; Fujishiro et al. 2011; Pai & Lee 2011; Taher 2010). Fujishiro et al. 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