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Workplace violence targeting student nurses in the clinical areas
Abstract
ENGLISH ABSTRACT: Workplace violence in health care is a worldwide phenomenon. In nursing, the nature of workplace violence is predominantly non-physical in nature. Literature reveals the devastating consequences for the individual nurse, both physically and / or emotionally, depending on the nature of the violence. The consequences for the organisation / institution and the profession are equally devastating, manifesting in reduced standards of patient care and increased attrition from the profession. The pervasiveness of this problem indicates that to date, remedial and protective measures have been unsuccessful. However, most of the research done on workplace violence in nursing has been conducted amongst qualified nurses. The purpose of this study was to investigate the extent of workplace violence, targeting student nurses in clinical areas. The setting was the Western Cape College of Nursing and the population was second, third and fourth-year, pre-registration students. The research objectives addressed various aspects, for example, type, prevalence, perpetrators, consequences and management of workplace violence. A quantitative research design, utilising a survey, was chosen for the study. A probability sample of n = 255 students was selected, using stratified, random sampling as the sampling method. The variables selected for stratification were gender and year of study. A self reported, anonymous questionnaire, guided by the literature review and by the research objectives, was utilised for data generation. Summary statistics were used to describe the variables, whilst distributions of variables were presented in the form of histograms and frequency tables. Where appropriate, the relationships between demographic and research variables were described, using suitable statistical analyses. The findings revealed that the perpetration of non-physical violence against student nurses is widespread, particularly that perpetrated by co-workers, more specifically registered, staff- and assistant nurses. The under reporting of workplace violence was a common finding. Student nurses suffer grave emotional consequences as a result of workplace violence. Almost half of the respondents admitted that they had considered leaving nursing due to workplace violence and that it had negatively affected their standard of patient care. The overall conclusion was that, in accordance with a worldwide trend amongst all categories of nurses, student nurses are targets of workplace violence in the clinical areas. These findings have particular implications for the management of nursing education institutions. The fact that student nurses are targeted to the extent revealed in this study indicates that existing preventive measures in the clinical areas have not been effective. The recommendations arising from this study therefore focus on equipping the vulnerable trainee with the tools to withstand workplace violence. As such, the recommendations are directed at the management of the nursing education institution, to create awareness around the problem, to empower students to confront and cope with workplace violence and to support students traumatised by workplace violence. Finally, this study suggests avenues for further research, for example, research in the same setting after implementation of the recommendations, or further research into the dynamics of workplace violence, targeting student nurses from the perspective of qualified nursing staff or patients. AFRIKAANSE OPSOMMING: Geweld in die gesondheidsdienste werksplek is ‘n wêreldwye verskynsel. In verpleging is geweld in die werksplek oorwegend nie-fisies van aard. Die literatuur wys op die ingrypende fisiese en / of emosionele gevolge vir die individuele verpleegkundige, afhangend van die aard van die geweld. Die gevolge vir die organisasie of instelling, asook vir die verpleegberoep, is eweneens ingrypend en manifesteer in verlaagde standaarde in pasiëntsorg en ‘n toename in verpleegkundiges wat die beroep verlaat. Die algemene verskynsel van die problem dui aan dat regstellende en beskermende maatreëls tot dusver onsuksesvol was. Die meeste navorsing oor geweld in verpleging is egter tot dusver onder gekwalifiseerde verpleegkundiges gedoen. Die doel van hierdie studie was om die omvang van werksplek-geweld, met studenteverpleegkundiges as teikengroep, in die kliniese areas na te vors. Die studie is by die Wes-Kaap Kollege van Verpleging uitgevoer en die populasie was al die tweede, derde en vierde-jaar, voor-registrasie studente. Die geformuleerde navorsingsdoelwitte vir die studie het verskeie aspekte aangespreek, soos byvoorbeeld, tipe, frekwensie, die uitvoerders van geweld, gevolge en die hantering van werksplek-geweld. ‘n Kwantitatiewe navorsingsontwerp, met gebruikmaking van ’n opname, is vir die studie geselekteer. ‘n Waarskynlikheidsteekproef van n = 255 studente is deur middel van gestratifiseerde, ewekansige steekproefneming geselekteer. Geslag en jaar van studie was as die veranderlikes vir stratifikasie gekies. Die instrument vir data-insameling was ‘n self-voltooide vraelys, gebaseer op die literatuurstudie en gerig deur die navorsingsdoelwitte. Opsommende statistieke is aangewend om die veranderlikes te beskryf, terwyl die verspreidings van veranderlikes in die vorm van histogramme of frekwensie-tabelle aangebied is. Waar toepaslik, is die verhoudings tussen demografiese en navorsingsveranderlikes met behulp van toepaslike statistiese analises beskryf. Die bevindinge het onthul dat die pleeg van nie-fisiese geweld teenoor studenteverpleegkundiges algemeen voorkom, veral daardie deur mede-personeel, meer spesifiek geregistreerde, staf– en assistent verpleegundiges. Die onderrapportering van werksplek-geweld was ‘n algemene bevinding. Studenteverpleegkundiges ly aan erge emosionele gevolge, as gevolg van werksplek-geweld. Byna die helfte van die respondente het erken dat hulle oorweeg het om die beroep te verlaat en dat sodanige geweld hul standaard van pasiëntsorg negatief beinvloed het. Die oorkoepelende gevolgtrekking was dat studenteverpleegkundiges, in ooreenstemming met ‘n wêreldwye neiging onder alle kategorieë van verpleegkundiges, die teiken van werksplek-geweld in die kliniese areas is. Hierdie bevindinge hou spesifieke implikasies vir die bestuur van verpleegonderriginrigtings in. Die feit dat studenteverpleegkundiges tot die mate, soos in die studie onthul, geteiken word, het aangetoon dat bestaande voorkomende maatreëls in die kliniese areas oneffektief is. Die voorstelle vanuit hierdie studie is dus daarop gerig om die ontvanklike nuweling toe te rus om werksplek-geweld teë te staan. As sulks is die voorstelle gemik op die bestuur van die verpleegonderrig-inrigting, om bewustheid rondom die probleem te skep, om studente te bemagtig om geweld te konfronteer en te hanteer, en om studente, wat as gevolg van werksplek-geweld getraumatiseer is, te ondersteun. Laastens word moontlikhede vir verdere navorsing voorgestel, soos byvoorbeeld, navorsing in dieselfde omgewing na die implementering van die voorstelle, of verdere navorsing in die dinamika van werksplek-geweld teenoor studenteverpleegkundiges, vanuit die perspektief van gekwalifiseerde verpleegpersoneel of pasiënte. Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010.
... Si bien existen estudios que examinan la violencia experimentada durante sus prácticas clínicas hacia los estudiantes de Enfermería, la mayoría de estos se han realizado en Reino Unido 13,20 , Nueva Zelanda 21 , Australia 22 , China 10 , Estados Unidos 12 , Irán 16 , Turquía 18,19 , Hong Kong 17 E. Pérez-Castro, J. Delgado-Delgado, y C. Bueno-Brito y algunos países de África 14,23 . En México y a nivel Latinoamérica no se tienen estudios que reporten la prevalencia y las experiencias de violencia/acoso en los estudiantes de Enfermería. ...
... El diseño del estudio fue transversal y la recolección de datos se realizó mediante un cuestionario de un estudio sudafricano aplicado a 218 estudiantes de Enfermería en 2010, el cual fue sujeto de validación por enfermeros e investigadores 23 . Dicho instrumento consta de 6 secciones con 66 ítems basados en la violencia en el lugar de trabajo, incluyendo la violencia no física, violencia física, la violencia/acoso sexual, perpetradores de violencia, impacto y consecuencias de la violencia en sentimientos y la denuncia/reporte. ...
... De acuerdo con diversos estudios, los efectos psicosociales de la violencia/acoso en algunos alumnos de este estudio produjeron sentimientos de estrés, ansiedad, vergüenza, miedo y humillación con algunos alumnos que consideraron dejar la profesión de enfermería 10,[15][16][17][18][19][20][21][22][23]25 . Los efectos negativos de estas emociones en el aprendizaje de los estudiantes pueden ser contraproducentes ya que, en última instancia, los estudiantes no pueden lograr la competencia clínica. ...
Resumen: Introducción: los estudiantes de Enfermería frecuentemente están expuestos a experimentar algún tipo de violencia durante las prácticas clínicas debido a su menor edad, menor experiencia social, mecanismos de defensa psicológica inmaduros, entre otros factores.El objetivo de este trabajo es determinar la prevalencia y experiencias de violencia durante prácticas clínicas intrahospitalarias en los estudiantes de Enfermería y la forma en que sus comportamientos y emociones se ven afectados. Material y métodos: estudio transversal en 327 estudiantes de Enfermería los cuales habían finalizado sus prácticas clínicas semestrales y desearon participar voluntariamente. Se utilizó un cuestionario validado para recopilar información sobre violencia no física, violencia física y acoso sexual. Resultados: el 76% de los estudiantes ha experimentado violencia no física, seguido de acoso sexual con 28,45%. Los pacientes fueron considerados como los principales perpetradores, seguidos del personal médico de base. Los sentimientos personales negativos más frecuentes fueron estrés (32,42%) y confusión (41,89%). Un estudiante de segundo año tiene más probabilidad de experimentar violencia no física (OR = 1,78; 1,05-3,07) y violencia sexual (OR = 1,87; 1,06-3,36). El 25% considera que la violencia es parte de las prácticas clínicas. Conclusiones: los estudiantes percibieron alta prevalencia de violencia no física, en menor proporción acoso sexual y violencia física con impacto negativo en los sentimientos personales. Abstract: Introduction: Nursing students are frequently exposed to experience some type of violence during clinical practice due to their younger age, less social experience, immature psychological defense mechanisms, among other factors.The objective of this work is to determine the prevalence and experiences of violence during in-hospital clinical practices in nursing students and how their behaviors and emotions are affected. Material and methods: Cross-sectional study in 327 nursing students who had completed their semester clinical placements and wished to participate voluntarily. A validated questionnaire was used to collect information on non-physical violence, physical violence and sexual harassment. Results: 76% of the students had experienced nonphysical violence, followed by sexual harassment with 28.45%. Patients were considered the main perpetrators, followed by the basic medical staff. The most frequent negative personal feelings were stress (32.42%) and confusion (41.89%). Conclusions: Students perceived high prevalence of non-physical violence, in lower proportion sexual harassment and physical violence with negative impact on personal feelings.
... El estudio utilizó como instrumento de medida un cuestionario adaptado del trabajo de Hewett (22) y Tee et al. (23), de quienes se obtuvo previamente el permiso para su utilización. Más concretamente, el cuestionario de Tee et al. es una adaptación del utilizado por Hewett en 2010, quién probó y desarrolló el cuestionario con estudiantes de Enfermería de Sudáfrica. ...
... Los datos obtenidos en nuestro trabajo concuerdan en líneas generales con los obtenidos en otros países como Reino Unido (11,23), Italia (6), Turquía (24), Canadá (12), EE.UU. (9), Sudáfrica (22) y Australia (1,25), utilizando todos ellos, eso sí, la misma metodología que la empleada en nuestra investigación. ...
... En nuestro estudio se halla una prevalencia autoevaluada del 26,5% en el último año, si bien es cierto que este porcentaje llega hasta el 40,3% de estudiantes que refieren estar en desacuerdo con la afirmación nunca ha sufrido intimidación y/o acoso en una de las últimas preguntas del cuestionario. Esta prevalencia es similar a la registrada en Italia o Reino Unido con un 34% (6) y 42,18% (23), respectivamente, pero inferior a la obtenida en otros países como Australia (50,1%) (1,25), Turquía (50,3%) (24), Sudáfrica (76%) (22), Escocia (77%) (11), más del 88% en Canadá (12) y alcanzando el 100% de prevalencia en EE.UU. (3). ...
Objective:
Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/or harassment experienced by Nursing students during their clinical practice.
Methods:
A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student's t-test and Mann Whitney U test were used for statistical analysis.
Results:
A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients.
Conclusions:
The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.
... El estudio utilizó como instrumento de medida un cuestionario adaptado del trabajo de Hewett (22) y Tee et al. (23), de quienes se obtuvo previamente el permiso para su utilización. Más concretamente, el cuestionario de Tee et al. es una adaptación del utilizado por Hewett en 2010, quién probó y desarrolló el cuestionario con estudiantes de Enfermería de Sudáfrica. ...
... Los datos obtenidos en nuestro trabajo concuerdan en líneas generales con los obtenidos en otros países como Reino Unido (11,23), Italia (6), Turquía (24), Canadá (12), EE.UU. (9), Sudáfrica (22) y Australia (1,25), utilizando todos ellos, eso sí, la misma metodología que la empleada en nuestra investigación. ...
... En nuestro estudio se halla una prevalencia autoevaluada del 26,5% en el último año, si bien es cierto que este porcentaje llega hasta el 40,3% de estudiantes que refieren estar en desacuerdo con la afirmación nunca ha sufrido intimidación y/o acoso en una de las últimas preguntas del cuestionario. Esta prevalencia es similar a la registrada en Italia o Reino Unido con un 34% (6) y 42,18% (23), respectivamente, pero inferior a la obtenida en otros países como Australia (50,1%) (1,25), Turquía (50,3%) (24), Sudáfrica (76%) (22), Escocia (77%) (11), más del 88% en Canadá (12) y alcanzando el 100% de prevalencia en EE.UU. (3). ...
FUNDAMENTOS // Los estudiantes de Enfermería, con su inexperiencia y el desafío frecuente de encontrarse con nuevos entornos, son un grupo potencialmente vulnerable para sufrir intimidación y acoso en el ámbito del trabajo. El objetivo de este trabajo fue analizar la intimidación y/o acoso padecidos por los estudiantes de Enfermería durante sus prácticas clínicas. MÉTODOS // Se realizó un estudio descriptivo transversal en la Universidad de León. La población a estudio fueron los estudiantes del Grado en Enfermería de cuarto curso. El instrumento de medida fue un cuestionario que constó de 24 items y que se aprobó por el Comité de Ética de la Universidad. Para el análisis estadístico se utilizó la prueba de chi-cuadrado, t de Student y la U de Mann Whitney. RESULTADOS // Se observó una prevalencia del 26,5% (n=83) de estudiantes que sufrieron episodios de intimidación y/o acoso; los estudiantes de menor edad padecieron estos hechos por parte de los médicos, pacientes y familiares y/o acompañantes en mayor medida. Esto produjo un impacto en su bienestar psicológico e hizo que se sintieran deprimidos, humillados e incapaces, lo que afectó negativamente al nivel de atención prestado a los pacientes. CONCLUSIONES // El problema global estudiado presenta una prevalencia inferior a la obtenida en otros trabajos llevados a cabo en el resto del mundo. Como consecuencia, existe un impacto en el bienestar psicológico de los estudiantes que afecta a su nivel de atención en las tareas que están llevando a cabo y a su forma de trabajar con los demás. PALABRAS CLAVE // Acoso escolar; Salud mental; Enseñanza de Enfermería; Estudiantes de Enfermería; Practicas clínicas; Violencia laboral. RESUMEN BACKGROUND // Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/ or harassment experienced by Nursing students during their clinical practice. METHODS // A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student's t-test and Mann Whitney U test were used for statistical analysis. RESULTS // A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients. CONCLUSIONS // The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.
... Some of the behaviors associated with bullying include excessive criticism, ridicule, excessive demands, and nonverbal innuendos (e.g., eye rolling and body language; Ahn & Choi, 2019). Furthermore, bullying behaviors can create feelings of insecurity, exclusion, anger, depression, anxiety, humiliation, feelings of inadequacy, and isolation for the victims (Hewett, 2010;Pepler et al., 2006;Whiteside et al., 2014;Yamada et al., 2014). ...
... Reviewing examples of themes from work done in those disciplines will provide context for the discussion of similar behaviors reported by students in speech-language pathology clinical practicum settings presented in this study. Hewett (2010) surveyed 218 South African student nurses. This was a quantitative study using stratified random sampling whose purpose was to describe and analyze workplace violence based on type, prevalence, perpetrators, consequences, and management. ...
... The results also revealed that, during the practicum, participants were experiencing sleep disturbance, crying in class, and having nightmares. Although there were no physical attacks perpetrated by the clinical educators, as reported in the nursing literature (Hewett, 2010), the psychological effects from the daily exposure to incivility had physical consequences, which was also noted across disciplines. The results indicated that the perpetrators of uncivil behaviors in the clinical education setting are clearly the clinical educators; however, because clinical supervision and clinical education are a bidirectional process (Anderson, 1988), the researchers were interested in knowing the perception of the student regarding their role in the emergence and persistence of uncivil behaviors. ...
Purpose
The purpose of this phenomenological study was to describe and interpret the experiences of graduate students in communication sciences and disorders who experienced forms of incivility in the clinical practicum setting. There is precedent for identifying and handling incivility, such as bullying, harassment, and intimidation, in the nursing education, psychology education, medical education, and physical therapy literature. A literature search for incivilities such as bullying, harassment, and intimidation in graduate student education in communication sciences and disorders did not yield any systematic studies.
Method
Nineteen participants who were interested in participating contacted the researcher; of those, nine participants were ultimately interviewed. A thematic analysis of videotaped semistructured interviews was used to measure outcomes based on the five questions posed to the participants. The participants responded to the five questions designed to understand the lived experience of incivility for graduate students in speech-language pathology practicum settings.
Conclusions
This study fills a gap in the clinical education literature in speech-language pathology. It was a qualitative study using a phenomenological approach that described and interpreted speech-language pathology graduate students' experiences of bullying, harassment, and/or intimidation during clinical practicums across practice settings. Data analysis yielded five themes based on the participants' responses during the interview. The themes were communication, physical and/or psychological effects, interpersonal dynamics, clinical instruction, and lingering physical and psychological effects of the experience. The authors make recommendations to reduce the probability that incivility, bullying, and/or intimidation will occur during a student's clinical practicum experience.
... Psychometric scales must be validated and reliable. Although there are various checklists 21,22 and scales 23,24 that can measure disruptive behavior, a previous study noted that few scales have been validated and shown to be reliable using multiple criteria. 25 That study suggested carefully following several steps and performing a detailed analysis of the validity and reliability of the scales to create a scale with high validity and reliability. ...
... 14,29 Therefore, we achieved our main aim of covering general disruptive clinician behaviors. Compared with the 5 existing scales reviewed in the Introduction section, sexual harassment (as included in the Student Experience of Bullying during Clinical Placement) 22 was absent. In contrast, power harassment and passive aggression related to professionalism were present in our scale. ...
Objectives
Disruptive clinician behavior worsens communication, information transfer, and teamwork, all of which negatively affect patient safety. Improving safety in medical care requires an accurate assessment of the damage caused by disruptive clinician behavior. Psychometric scales complement case reports, but existing scales have significant limitations. Therefore, this study developed a psychometric scale based on the psychological paradigm to assess disruptive clinician behavior.
Methods
The scale was developed through a sequence of steps. First, we used an open-ended questionnaire targeting 712 nurses, content analysis, and content validity assessment by 5 experts to determine valid items for disruptive clinical behavior. Next, an Internet questionnaire survey targeting 1000 health care staff, exploratory factor analysis, and subfactor analysis was conducted to identify necessary and sufficient factors. Then, we calculated difficulty level and discriminative power. We also conducted a field questionnaire survey targeting 84 staff in a hospital. Finally, we calculated ω coefficients and then used confirmatory factor analysis to verify the fit of the hypothesized model.
Results
Our open-ended survey involving 478 nurses identified 47 codes in 9 categories. The questionnaire survey involving hospital 1000 medical staff identified 6 factors, with 1 factor subdivided into 4 subfactors and 1 into 2 subfactors. The goodness of fit of the hypothesized 10-factor models with factor pairs and groups was confirmed.
Conclusions
We developed a psychometric scale measuring subjective assessments of harm covering various disruptive clinician behaviors. The scale complements interviews and case reports by generating valid, reliable scores for various disruptive clinician behaviors in health care institutions.
... Workplace Violence Scale was developed and tested by Hewett (2010). The tool comprised five sections with 66 individual items relevant to WV including, intimidation, bullying or verbal abuse, non-physical violence, and reporting and management of WV. ...
... The tool comprised five sections with 66 individual items relevant to WV including, intimidation, bullying or verbal abuse, non-physical violence, and reporting and management of WV. The questionnaire used mainly closed questions that were rated using a four-point response scale on frequency, with an opportunity for respondents to provide textual descriptions (Hewett, 2010). The content validity of the original tool was established via a pilot study and adapted by researchers in Turkey. ...
Background
Workplace violence (WV) within nursing has been recognised internationally as a significant problem. In developing countries, such as Turkey, where nurses face WV frequently, it is an under-researched area and there is an absence of an effective system for reporting such acts.
Aim
This study aimed to identify the incidence of WV experienced by Turkish nursing students, and to explore the implications and actions needed to reduce the incidence and impact.
Methods
This study employed a cross-sectional design. Data were collected from 1216 nursing students using the student nurse datasheet and the workplace violence scale.
Findings
The workplace has a considerable impact on nursing students and to varying degrees, WV affects more than half of nursing students in Turkey. The types of WV ranged from receiving racist remarks and being shouted at, to being kicked or having an unwanted advances for intimate physical contact.
Discussion
The findings from this study add to the evidence that violence amongst nursing students is almost a daily occurrence, and is also underreported. Having an understanding of nursing students’ experiences and the impacts of WV, along with effective systems for reporting, can help mitigate the risk of violence occurring during clinical practice. Undergraduate nursing programs and continuing education for nurses should include preparation and role play on how to handle and report WV to improve the resilience of students. It is only through such a concerted and proactive approach will we promote more positive perceptions towards nursing programmes and the nursing profession as a whole.
... Bullying has been defined by Hewett (2010) as "aggressive behaviour towards another person, or object of that person, finding expression in physical assault, sexual harassment and non-physical violence, such as verbal abuse, incivility and intimidation" (p.10). The term bullying can be used interchangeably with words such as harassment, incivility and horizontal or vertical violence (Courtney-Pratt et al., 2018;Seibel, 2014). ...
... The target population was all students enrolled in a Bachelor of Nursing undergraduate degree in New Zealand. The study used the Student Experience of Bullying During Clinical Placement (SEBDCP) survey which was developed by Budden et al., based on early work by Hewett (2010) in her study of undergraduate nursing students in South Africa. The survey had been used in studies of Australian (Birks, Budden et al., 2017) and UK nursing students (Tee et al., 2016). ...
Background
Bullying in nursing is not a new phenomenon and nursing students are not exempt from its effects, however there is limited literature that deals directly with bullying of nursing students within the clinical environment in New Zealand. Quality clinical placements are vital to facilitate the link between theory and practice whilst working in complex healthcare settings.
Aim
The purpose of this article is to present the experiences described by nursing students regarding the nature and extent of bullying during clinical placements.
Design
This study employed a cross-sectional survey design using an electronic survey in which this paper focuses on the textual data provided by nursing students from across New Zealand. Data was analysed by coding and grouping into themes.
Results
There were numerous uncivil behaviours students were subject to during clinical placements. The consequences of these behaviours had physical, psychological and financial implications for students, with some suggestions that they choose to leave the nursing profession.
Conclusions
Predominantly the practice setting is clearly not nurturing enough for nursing students; a situation unlikely to change in the near future. Hence academic institutions must be proactive in developing students' ability to address incivility in these environments and to educate their own staff on how to recognise and respond to bullying in the clinical arena.
... In the healthcare literature, the term bullying is often used interchangeably with workplace violence, aggression, incivility and harassment. Hewett (2010) described degrees of aggression towards another individual that could be expressed as physical or non-physical abuse. Bullying in nursing is prevalent and visible and is the antithesis of caring, which is the foundation of the profession (Adams and Maykut, 2015). ...
... The two studies reported here employed a cross-sectional survey design, utilising the Student Experience of Bullying during Clinical Placement (SEBDCP) questionnaire (Budden et al., 2017). The questionnaire was developed from the work of Hewett (2010) and adapted for the Australian and, subsequently, the UK contexts. The SEBDCP comprised 13 main questions with more than 80 items, most requiring a rating of frequency of occurrence: 'Never' (0 times); 'Occasionally' (1e2 times); 'Sometimes' (3e5 times) and 'Often' (>5 times). ...
... It has been estimated that workplace bullying/harassment costs between 6 and 36 billion dollars annually to the Australian economy (Parliament of the Commonwealth of Australia, 2012). Many other definitions exist and one by Hewett (2010) described workplace violence as ''aggressive behaviour towards another person, or object of that person, finding expression in physical assault, sexual harassment and nonphysical violence, such as verbal abuse, incivility, bullying and intimidation'' (p. 10). ...
... This study employed a cross-sectional survey design, utilising an instrument adapted from the work of Hewett (2010), who developed and tested the tool with 218 undergraduate nursing students in South Africa. Content validity of the original tool was established via a pilot study. ...
... It has been estimated that workplace bullying/harassment costs between 6 and 36 billion dollars annually to the Australian economy (Parliament of the Commonwealth of Australia, 2012). Many other definitions exist and one by Hewett (2010) described workplace violence as ''aggressive behaviour towards another person, or object of that person, finding expression in physical assault, sexual harassment and nonphysical violence, such as verbal abuse, incivility, bullying and intimidation'' (p. 10). ...
... This study employed a cross-sectional survey design, utilising an instrument adapted from the work of Hewett (2010), who developed and tested the tool with 218 undergraduate nursing students in South Africa. Content validity of the original tool was established via a pilot study. ...
Bullying and harassment in nursing are unacceptable behaviours in the workplace. There is a large body of evidence relating this problem, however little of it focuses on the experiences of nursing students. This prospective cross-sectional survey investigated Australian undergraduate nursing students' (N = 888) experiences of bullying and/or harassment during clinical placement. Half (50.1%) of the students indicated they had experienced this behaviour in the previous 12 months. Younger students were more likely to be bullied/harassed than older students (p = 0.05). Participants identified perpetrators of bullying/harassment as registered nurses (56.6%), patients (37.4%), enrolled nurse's (36.4%), clinical facilitators (25.9%), precep-tors (24.6%), nurse managers (22.8%) and other student nurses (11.8%). The majority of students reported that the experience of being bullied/harassed made them feel anxious (71.5%) and depressed (53.6%). Almost a third of students (32.8%) indicated that these experiences negatively affected the standard of care they provided to patients with many (46.9%) reconsidering nursing as their intended career. In the face of workforce attrition in nursing, the findings of this study have implications for education providers, clinical institutions and the profession at large.
... It has been estimated that workplace bullying/harassment costs between 6 and 36 billion dollars annually to the Australian economy (Parliament of the Commonwealth of Australia, 2012). Many other definitions exist and one by Hewett (2010) described workplace violence as ''aggressive behaviour towards another person, or object of that person, finding expression in physical assault, sexual harassment and nonphysical violence, such as verbal abuse, incivility, bullying and intimidation'' (p. 10). ...
... This study employed a cross-sectional survey design, utilising an instrument adapted from the work of Hewett (2010), who developed and tested the tool with 218 undergraduate nursing students in South Africa. Content validity of the original tool was established via a pilot study. ...
Bullying and harassment in nursing are unacceptable behaviours in the workplace. There is a large body of evidence relating this problem, however little of it focuses on the experiences of nursing students. This prospective cross-sectional survey investigated Australian undergraduate nursing students’ (N = 888) experiences of bullying and/or harassment during clinical placement. Half (50.1%) of the students indicated they had experienced this behaviour in the previous 12 months. Younger students were more likely to be bullied/harassed than older students (p = 0.05). Participants identified perpetrators of bullying/harassment as registered nurses (56.6%), patients (37.4%), enrolled nurse's (36.4%), clinical facilitators (25.9%), preceptors (24.6%), nurse managers (22.8%) and other student nurses (11.8%). The majority of students reported that the experience of being bullied/harassed made them feel anxious (71.5%) and depressed (53.6%). Almost a third of students (32.8%) indicated that these experiences negatively affected the standard of care they provided to patients with many (46.9%) reconsidering nursing as their intended career. In the face of workforce attrition in nursing, the findings of this study have implications for education providers, clinical institutions and the profession at large.
Keywords:
Bullying, Harassment, Incivility, Nursing students, Workplace violence, Clinical placement
... The questionnaire in the current study was adapted from Hewett [24]. The questionnaire consists of six parts, including (a) demographic (including Age, Gender, Marital Status, and Wearing Hijab for females) and educational data (including Year of Study, Type of Program, and University type), (b) verbal (12 items), physical (8 items), and sexual harassment (6 items) in clinical areas, (c) data about the perpetrator (12 items) and the settings The tool consists of 67 items; each item rated the occurrence of harassment or the impact of harassment on a four-point Likert scale (0 -Never to 3 -Often: more than 5 times). ...
Introduction
Nursing students experienced various types of bullying and abuse in their practice areas. This study aims to assess the incidence, nature, and types of bullying and harassment experienced by Jordanian nursing students in clinical areas.
Methodology
A cross-sectional, descriptive design was used, utilizing a self-report questionnaire. A convenient sampling technique was used to approach nursing students who are in their 3rd or 4th year in governmental and private universities.
Results
Of 162 (70%) students who reported harassment, more than 80% of them were females and single. Almost 40% of them reported that males were the gender of the perpetrator. Almost 26.5% of them reported that patient’s relatives or friends were the sources of harassment. Psychological/verbal harassment was the most reported type of harassment (79%). Findings showed that there was a statistically significant difference in psychological/verbal harassment based on gender and type of the university. Also, there were significant negative correlations between psychological/verbal harassment, professional achievement, and personal life.
Conclusion
Harassment in the clinical area is affecting the professional and personal lives of students, who lack the knowledge of policy to report this harassment.
... Thus, power harassment is a DCB in which a superior imposes unreasonable words and actions on a subordinate based on their authority. Sexual harassment is limited to the number of victims and has only been identified as an independent category in studies on DCB victimization among nursing students [37]. ...
This article discusses issues and perspectives related to the study of disruptive clinician behavior (DCB) to improve patient safety and healthcare professionals’ work environments. Multiple terminologies and ambiguous definitions have resulted in conceptual confusion in studies on DCB. In addition, subjective classifications have led the attributes of DCB to overlap and fluctuate. Therefore, we share Rosenberg’s definition of DCB as “any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical and sexual harassment.” It is recommended that DCB be understood as a hierarchical structure identified through statistical analysis of field survey data. Furthermore, a recurring list of items is duplicated across existing studies on DCB triggers, contributing factors, and influences. These items can be organized into separate path models based on their mutual relationships. Given these assumed models, we believe that further studies on DCB can shift toward elucidating the mechanisms of occurrence and impact. Finally, based on the path models, we recommend improving healthcare professionals’ psychological and social states through a policy shift from “zero-tolerance” to “to err is human” as a priority issue for DCB prevention and countermeasures.
... The study utilised a valid instrument (the Student Experience of Bullying During Clinical Placement (SEBDCP) survey) previously trialled and used in studies of Australian (Budden, Birks, Cant, Bagley, & Park, 2017) and UK nursing students (Tee, Özç etin et al., 2016;Tee, Uzar Ozcetin et al., 2016) which was based on the work of Hewett (2010). This instrument comprised a total of 91 items, in 13 main questions, asking about bullying and/or harassment, (including intimidation, physical or verbal abuse and non-physical violence), and the reporting and management of such incidents. ...
Background: Bullying in nursing is a global problem that has been explored and reported within the literature. There is however, limited literature that deals directly with bullying of nursing students in the clinical setting in New Zealand. Aim: This prospective cross-sectional survey investigated New Zealand undergraduate nursing students' experiences of bullying and/or harassment during clinical placement. An electronic survey was conducted between August and October 2017. Findings: Responses of 296 Bachelor of Nursing students across the three years of the course were analysed using descriptive and inferential statistics. Forty percent (40%; 118) of students experienced being bullied while on clinical placements. There was a significant increase in the incidence of bullying as students progressed through the degree, with the highest proportion of bullying occurring in the hospital setting. The main perpetrators of bullying were registered nurses, with preceptors, mentors and clinical facilitators being the most cited perpetrators. Experiences of being bullied resulted in feelings of anxiety in students and negatively affected students' clinical learning. Only 27% of respondents who were bullied had self-reported an episode of bullying and respondents indicated they were not satisfied with the outcome , were often uncertain whether any action was taken, and/or felt penalized for reporting bullying. Nursing students are a vulnerable group and these findings have implications for all nurses who work with students during their undergraduate degree.
... The original survey tool was produced by Hewett (2010) who developed the instrument for her study of 218 undergraduate nursing students in South Africa. To ensure relevance to the local context, terminology used throughout the tool was adapted and a number of items were added. ...
Background: Bullying in nursing remains an unacceptable international phenomenon and one that is widely reported in the literature. Recently, reports of bullying and harassment of nursing students have been increasing. Aim: This paper aims to describe bullying and harassment experienced by Australian nursing students while on clinical placement, as told by the participants. Methods: As part of a larger study, 884 Australian baccalaureate nursing students were surveyed to identify the nature and extent of their experiences of bullying and/or harassment during clinical placement. Almost half of the students (430) provided open-ended comments. These textual data were explored using a content analysis approach. Findings: The major themes derived from the analysis consisted of: manifestations of bullying and harassment ; the perpetrators, consequences and impacts. Bullying behaviours included various forms of verbal, racial, physical and sexual abuse. Perpetrators of bullying included other nurses, medical professionals, administrative and support staff. Students reported anxiety, panic attacks, physical symptoms of distress and loss of confidence and self-esteem from their experience of bullying during clinical placement. Discussion: Bullying in nursing is a widespread yet poorly understood phenomenon that impacts negatively on the learning experience of vulnerable nursing students, effecting them physically, mentally and emotionally. The potential implications of the bullying of nursing students on patient care reinforces the need for the culture of bullying that exists amongst the nursing profession to be addressed. Conclusion: The findings of this research have implications for nursing educators and clinicians. Recommendations include ensuring adequate preparation of students, clinical instructors and registered nurses who work with students in the practice environment.
... The original survey comprised five sections with 66 individual items based around workplace violence including intimidation, bullying or verbal abuse, non-physical violence, and reporting and management of workplace violence. The questionnaire used mainly closed-ended questions that were rated using a 4-point response scale on frequency, with opportunity for respondents to provide textual descriptions (Hewett, 2010). Content validity of the original tool was established via a pilot study and adapted by researchers in James Cook University, Australia (Birks et al., 2014). ...
... Some nurses mentioned a lack of confidence in their employers and the absence of a reporting system (Zampieron et al., 2010). Hewett (2010) revealed that nurses were reluctant to report violence to the authorities because of the fear of victimization, ignorance about where or how to report it, and the perception or feeling that nothing would get done about it. Nelwati and Plummer (2013) revealed the following coping mechanism for abused nurses: ...
Workers who provide services in the remote or high crime areas, work shift hours and/ or have a great deal of contact with the public as employees are at a higher risk to encounter violence in the workplace. The violence that occurs at work refers to a broad spectrum of behaviours such as violent acts by patients, visitors or co-workers that result in a concern for personal safety. Nurses are experiencing physical threats, verbal abuse, psychological and imminent violence on a regular basis. The purpose of the study is to explore the extent to which nurses are victimised by patients. The paper used secondary data, collected from various scholarly documents on victimisation of nurses. Literature revealed that nurses are exposed to overwhelming violence with severe consequences. Low staffing was among various contributory factors heightening victimisation of nurses by patients. Nurses' risk factors include age, gender, years of experience, hours worked, marital status and previous workplace violence training. It could be deduced from the findings of the study that lack of policies and protocols in the workplace is an aggravating factor for victimisation of nurses. The study recommends creation and dissemination of clear policy of zero tolerance for workplace violence, verbal and non-verbal threats and related actions.
... Some nurses mentioned a lack of confidence in their employers and the absence of a reporting system (Zampieron et al., 2010). Hewett (2010) revealed that nurses were reluctant to report violence to the authorities because of the fear of victimization, ignorance about where or how to report it, and the perception or feeling that nothing would get done about it. Nelwati and Plummer (2013) revealed the following coping mechanism for abused nurses: ...
A quantitative study using a cross-sectional survey design was conducted to determine the factors affecting the use of male condoms amongst male and female third year undergraduate students at a rural university in South Africa. A protocol based on several short standardised questionnaires was used. Demographic questions (sex and age) and an open ended question were added to give a more holistic element to the research. Two hundred (200) questionnaires were handed out and one hundred and ten (110) were correctly filled in and returned. Data were analysed using descriptive statistics and Thematic Content Analysis (TCA). It was concluded that although knowledge relating to male condom use was good, and the majority of respondents understood how to use one, it did not mean they used male condoms consistently. Qualitative results gleaned from the open-ended question revealed that male condoms are seen as untrustworthy and are viewed as culturally inappropriate as they are not, " out of Africa. " Qualitative results also suggest that patriarchal norms affect the use of male condoms.
... According to Woelfle and McCaffery (2007), horizontal violence is defined as any act or behavior of hostility or aggression, which could be oral, emotional, or physical, carried out by a coworker towards another coworker. 2 There are many forms of horizontal violence experiencing by nurses in different areas ranging from covert non-verbal insinuations to overt physical violation 3, 4, 5 . In her 2004 article, Dr. Griffin listed the most frequent lateral violence behaviors faced by nurses in different settings , beginning with nonverbal innuendo as the most frequent behavior followed by verbal affront, undermining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and finally broken confidences 6 . ...
Horizontal violence is one of devastating issues as being an obstacle in developing nursing profession. Objective: To identify nurses' perceptions toward horizontal violence in health care settings in Taif City in Saudi Arabia. Method: Quantitative descriptive correlational design was conducted on 100 nurses in selected settings in Taif city, Saudi Arabia. Results: 94% of nurse participants in this study witnessed at least one type of horizontal behaviors during their work. Findings revealed that covert behaviors were more common than overt ones. Covert acts of horizontal violence as perceived by nurse participants focuses mainly on lack of respect and communication between nurses. Fear of retaliation, fear of being ridiculed if asking questions, discouragement and job dissatisfaction were the most common effects of horizontal violence. Participants perceived that Peers including registered nurses and practitioner nurses were the most common perpetrators of horizontal violence. Conclusion: Although horizontal violence was extensively covered in nursing literature, this study demonstrated incessant existence of this problem. Horizontal violence has mischievous effects that extend from the nurse victims to the whole health care team and eventually to the patients. Developing educational programs on appropriate professional behaviors and code of nursing ethics and training courses on conflict managements for nursing staff and managers, is so effective in elimination with horizontal violence cases.
Data from international investigations indicate that gender‐based violence is a phenomenon that also occurs in the university environment. Despite the fact that clinical learning environments have been widely studied, little attention has been paid to sexual violence in the clinical placement setting of Health Sciences students. Consequently, the aim of this study was to describe situations and/or behaviours of harassment, such as assault and/or sexual abuse experienced by the students of one university in Barcelona, Spain, during their clinical placements. A cross‐sectional study was conducted using an ad‐hoc online questionnaire. A convenience sample was used including bachelor's degree students as subjects during their clinical placements in the second half of 2022. A total of 156 responses were collected from the students of four degrees (Nursing, Physiotherapy, Nutrition and Dietetics and Pharmacy). Of the total results collected, 74.5% (117) corresponded to women and the remaining 25.5% (40) to men. 71.3% of students reported that they had experienced one (or more) of the 25 types of conduct described in the questionnaire at some time. The behaviours of social interaction with sexual content and sexual harassment in the placement setting showed that such behaviours were mostly experienced by women on the Nursing degree. In relation to the perpetrators of such behaviours, the respondents manifested that the greatest aggressor was a patient and that most of the aggression took place in hospitalisation units, rehabilitation centres and nursing homes. It is essential that academic institutions, in collaboration with health institutions, carry out joint actions, awareness‐raising, identification and interventions, with students, professionals and teams from a culture of non‐violence and the eradication of sexual harassment in academic placements.
Workplace violence encompasses physical violence, verbal abuse, sexual harassment, bullying, and threatening behaviors. Reviews indicate that it is widely prevalent among healthcare professionals, but there is a lack of well-designed reviews specifically focusing on nursing students. This review aimed to synthesize the global prevalence and factors associated with workplace violence against nursing students, and prevalence estimates based on the different types of violence and perpetrators. A three-step search strategy included studies since inception from six electronic databases. Studies meeting eligibility criteria were included. Meta-analyses, subgroup, and meta-regression analyses were used to synthesize pooled prevalence rates. Thirty studies involving 10,955 nursing students were included. This review revealed that 55.1 % of nursing students have encountered workplace violence. Nursing undergraduates exhibited a significantly higher prevalence rate compared to a mixed group of undergraduates with diverse nursing or student profiles. Verbal abuse (53.3 %) and bullying (43.6 %) emerged as the most widespread forms of workplace violence, with nurses (24.2 %) and patients (22.8 %) being the most frequent perpetrators. This study suggests that academic and healthcare organizations develop stringent policies to combat workplace violence against nursing students. Future research may also focus on workplace violence risk factors and their long-term impacts on nursing students.
Purpose: The purpose of this study is to identify the trends related to nursing students’ experiences of violence and to propose a method to build a practice environment safe from violence in nursing students’ practicums.Methods: Using three databases, data on the experiences of violence in nursing student practice recorded in domestic studies from 2011 to 2022 were collected and analyzed.Results: In this study, 23 studies were analyzed, of which 19 were quantitative, four were qualitative study. In a survey conducted on the experiences of violence among nursing students during practice, verbal and physical violence, sexual harassment, and physical threats were found, and the perpetrators of the violence were patients, guardians, nurses, doctors, and hospital staffs. It was also found that the experiences of violence in nursing students' practice were negatively related to occupational identity, depression, burnout, and stress.Conclusion: It is necessary to develop an intervention program to reduce depression and increase self-esteem in order to better establish a student's career identity and to prepare a plan to build safe practices for nursing students.
Aim:
To assess the prevalence of violence and experiences of violence during clinical placements, among nursing students at a Higher Education Institution (HEI) in Scotland.
Design:
Cross-sectional survey, using an opt-in online questionnaire.
Participants:
All 950 undergraduate nursing students aged 18 + years were eligible.
Methods:
The survey, with 24 open and closed format questions, was advertised over a 6-week period via the students' virual learning platform. Potential participants were provided with study information before giving (electronic) informed consent. The questionnaire used was adapted from two other surveys and piloted prior to administration. Open-ended questions were fully transcribed and categorised and data analysed using SPSS.
Results:
There were 138 completed questionnaires (approx. 15% response rate); respondents were mainly female (92%). 77% had experienced verbal violence directed at them while on placement, most commonly swearing, shouting and insults. 70% of respondents had experienced physical violence, most commonly hitting, grabbing, kicking and spitting. By the fourth year of study, all 10 students who responded (out of 17 enrolled) had experienced violence. In general, patients (with a mental illness) were perceived to be the most likely perpetrators. The five most commonly reported feelings by respondents during the incident were: anxious (65), understanding (58), vulnerable (54), unsafe (50) and scared (45) and those after the incident were understanding (70), anxious (59), guilty (37), vulnerable (36), incompetent (34). 55 (47.8%) respondents felt supported during this 'significant' incident, 23 (20.0%) were unsure and 28 (24.3%) did not feel supported. There was a trend towards younger respondents and those with fewer years of care experience experiencing more violence.
Conclusion:
This study indicates that there is a high prevalence of violence experienced by student nurses that can have significant emotional consequences. There is scope to provide more training and support for them to deal with frequent incidents of violence.
Background: Workplace violence (WPV) directed at healthcare teams is a widespread growing phenomenon that affects students as well. The negative consequences of WPV may impede patient care and future retention rates. Purpose: To explore (a) the incidence and type of WPV experienced by nursing and medical students during their clinical rotations; (b) the associations between the emotional consequences of WPV events for students and their perceived professional performance; (c) students’ preparedness and current training on WPV.
Method: One hundred and fifty-one Israeli nursing and medical students completed an online questionnaire that included closed and open-ended questions. Quantitative data and qualitative data were analyzed separately, before their integration.
Results: More than half the students reported having experienced verbal violence during their clinical rotations. Experiencing WPV caused some students (14.6%) to consider leaving the profession and about one third (27.8%) reported that it had affected patients’ care. The vast majority of students did not report experiencing incidents of physical violence.
Conclusions: There is an essential need to promote and implement multidisciplinary programs aimed at eliminating WPV, beginning at the students’ level. Students need preparation and practical tools for coping with WPV. At the same time, health organizations must act to examine how cases of WPV against students are handled.
Objectives
To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.
Design
Systematic literature review of quantitative and qualitative empirical studies.
Data sources
Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.
Eligibility criteria
Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.
Data extraction and synthesis
Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.
Results
Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.
Conclusions
Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.
Overview: Providing safe, error-free care is the number-one priority of all health care professionals. Excellent outcomes have been associated with procedural efficiency, the implementation of evidence-based standards, and the use of tools designed to reduce the likelihood of medical error (such as computerized medication orders and bar-coded patient identification). But the impact of work relationships on clinical outcomes isn’t as well documented.
The current survey was designed as a follow-up to a previous VHA West Coast survey that examined the prevalence and impact of physicians’ disruptive behavior on the job satisfaction and retention of nurses (see “Nurse–Physician Relationships: Impact on Nurse Satisfaction and Retention,” June 2002). Based on the findings of that survey and subsequent comments on it, the follow-up survey examined the disruptive behavior of both physicians and nurses, as well as both groups’ and administrators’ perceptions of its effects on providers and its impact on clinical outcomes.
Surveys were distributed to 50 VHA hospitals across the country, and results from more than 1,500 survey participants were evaluated. Nurses were reported to have behaved disruptively almost as frequently as physicians. Most respondents perceived disruptive behavior as having negative or worsening effects, in both nurses and physicians, on stress, frustration, concentration, communication, collaboration, information transfer, and workplace relationships. Even more disturbing was the respondents’ perceptions of negative or worsening effects of disruptive behavior on adverse events, medical errors, patient safety, patient mortality, the quality of care, and patient satisfaction. These findings suggest that the consequences of disruptive behavior go far beyond nurses’ job satisfaction and morale, affecting communication and collaboration among clinicians, which may well, in turn, have a negative impact on clinical outcomes. Strategies aimed at reducing the incidence and impact of disruptive behavior are recommended.
Background. Interpersonal conflict among nurses (traditionally called ‘horizontal violence’ or ‘bullying’) is a significant issue confronting the nursing profession. However, there is a dearth of research focusing on horizontal violence experienced by new graduate nurses.
Aims. In order to assess the priority for preventive intervention programmes, the aims of this study were to determine the prevalence of horizontal violence experienced by nurses in their first year of practice; to describe the characteristics of the most distressing incidents experienced; to determine the consequences, and measure the psychological impact, of such events; and to determine the adequacy of training received to manage horizontal violence.
Method. An anonymous survey was mailed to nurses in New Zealand who had registered in the year prior to November 2000 (n = 1169) and 551 completed questionnaires were returned (response rate 47%). Information was requested on the type and frequency of interpersonal conflict; a description of the most distressing event experienced; the consequences of the behaviour; and training to manage such events. The Impact of Event Scale was used to measure the level of distress experienced.
Results. Many new graduates experienced horizontal violence across all clinical settings. Absenteeism from work, the high number of respondents who considered leaving nursing, and scores on the Impact of Event Scale all indicated the serious impact of interpersonal conflict. Nearly half of the events described were not reported, only 12% of those who described a distressing incident received formal debriefing, and the majority of respondents had no training to manage the behaviour.
Conclusions. First year of practice is an important confidence-building phase for nurses and yet many new graduates are exposed to horizontal violence, which may negatively impact on this process. The findings underscore a priority for the development of effective prevention programmes. Adequate reporting mechanisms and supportive services should also be readily available for those exposed to the behaviour.
Workplace violence pervades the healthcare setting. This study describes workplace violence events (WPVE) by type, frequency, perpetrator, and contributing factors and explores the relationship between WPVE and a history of childhood/adult abuse. Sixty-seven randomly selected registered nurses responded to the study. Both closed and open-ended responses were obtained. The majority of nurses experienced WPVE, typically emotional and verbal events. Physicians were commonly the perpetrators. Contributing factors included drugs, poor staffing, hospital location, gangs, easy access to triage, long hours worked, no training, power/control, stress, and negative characteristics of perpetrators. Over half of the nurses reported being victims of childhood or adult abuse; this abuse history was found to influence type (sexual and physical), frequency, and timing of WPVE. In an effort to prevent and reduce the frequency of WPVE, risk assessments of all health care environments should be made, followed with education discussing prevalency, type of WPVE, perpetrators, and contributing factors, including past victimization.
The authors developed and assessed the psychometric properties of an instrument measuring risk for workplace violence and expanded a model linking (a) risk and experience of violence and aggression from the public and (b) experience of aggression from coworkers to emotional well-being, psychosomatic well-being, affective commitment, and turnover intentions. Using data from 254 employees representing 71 different occupations, the measure demonstrated acceptable within-occupation and 1-month test-retest reliability. The data supported the model and showed that public-initiated violence and aggression and coworker-initiated aggression were differentially associated with personal and organizational outcomes.
Violence and aggression experienced by emergency nurses has been the focus of international concern. This paper examines the phenomena of violence experienced by emergency department nursing staff from an international perspective by reviewing original, published research studies. Methodological inconsistencies and concerns, a lack of comprehensive studies and persistent under-reporting may mean that the reality of clinical practise has not being captured by researchers. The literature suggests that clients presenting with weapons in the emergency department may be characteristic of North American departments but is much less likely to occur in the United Kingdom were weapons use is much more likely to be opportunistic. Excessive verbal abuse is a global phenomenon and nursing staff and organisations may be significantly affected by workplace violence. However, violence against nursing staff remains poorly researched or understood.
Incidents of workplace violence have been of significant concern to health care employers and the public at large. Many employers now find themselves confronted with sentinel events in the workplace, such as assault; property damage; racially, ethnically, or religiously motivated violence; sexual assault; employee suicide; or homicide. Regardless of a health care agency's size or mission, when employees are unexpectedly confronted with workplace violence, they are typically overwhelmed with shock and multiple questions surrounding how the event could have occurred in the safety of the workplace. It is difficult to imagine returning to work only minutes after hearing such news and, yet, in this modern era of corporate health care, this is what usually happens. Awareness of the dynamics and issues related to workplace violence can guide policy development and related interventions to promote safety, stability, and provide a platform for adapting to the devastation of such a disturbing event.
This paper reports some of the findings from the first qualitative stage of a large national study of bullying in the nursing workplace currently being undertaken in Australia. The findings reported here reveal how relationships between bullies were embedded within informal organizational alliances, enabling bullies to control work teams and use emotional abuse and psychological violence as a means of enforcing bully-defined 'rules of work'. Within nursing teams, bullies controlled work roles, tasks, and status in the nursing hierarchy through enforcing their 'rules'. Bullies enforced these rules through a process of ritual indoctrination, destroying the self-confidence and self-image of those targeted, and forcing them to eventually resign their position or acquiesce to survive. The merciless, calculated and deliberate nature of the bullying resulted in profound harm for many of those targeted. The findings of this research have implications for the understanding and management of workplace bullying.
This paper presents the results on workplace violence from a larger study undertaken in 2004. Comparison is made with the results of a similar study undertaken in 2001. The study involved the random sampling of 3,000 nurses from the Queensland Nurses' Union's membership in the public (acute hospital and community nursing), private (acute hospital and domiciliary nursing) and aged care (both public and private aged care facilities) sectors. The self-reported results suggest an increase in workplace violence in all three sectors. Although there are differences in the sources of workplace violence across the sectors, the major causes of workplace violence are: clients/patients, visitors/relatives, other nurses, nursing management and medical practitioners. Associations were also found between workplace violence and gender, the designation of the nurse, hours of employment, the age of the nurse, morale and perceptions of workplace safety. Although the majority of nurses reported that policies were in place for the management of workplace violence, these policies were not always adequate.
The occurrence of workplace violence is rather frequent within the nursing profession, with well-known consequences on the psychological health of victims.
This study is aimed at assessing the relationships between relevant individual, organizational, and psychosocial factors, and the frequency of several types of workplace violence; the direct as well as the interactive impact of violence and psychosocial factors on organizational commitment and perceived health.
Questionnaire-based cross-sectional and longitudinal survey designs were employed for the two study objectives, respectively.
Five hundred and sixty-five healthcare institutions from eight European countries participated in the Nurses' Early Exit Study.
The 34,107 participants were nursing staff holding different qualifications. The response rate was 55.1% in the cross-sectional part and 40.5% in the follow-up phase. At baseline, the respondents were mostly female (89.3%), in the age group 30-44 years (52.9%), registered or specialized nurses (67.0%), working mainly in medico-surgical wards (36.3%), and employed full-time (72.8%).
In the cross-sectional analysis, the relationship between the predictor variables and frequency of violence was assessed by means of a hierarchical multiple linear regression. In the longitudinal analysis, main direct and interactive effects of violence and psychosocial factors on perceived health and organizational commitment were assessed by means of hierarchical multiple linear regression analyses with interaction terms.
Higher levels of adverse work-related factors were significantly associated with higher frequency of the distinguished types of violence. Significant interactions were found between psychosocial factors and violence only in predicting organizational commitment, even if effect sizes were very low. No interactions were observed for perceived health. The prevalence of the distinguished types of violence varied across the participating countries according to the presence of adverse work- and non-work-related factors.
These findings suggest the necessity of interventions both over working conditions conducive to violence and violent behaviours themselves.
This chapter is focused specifically on health workers’ experiences of occupational violence/bullying. The discussion begins with an overview of the research evidence about the different forms of occupational violence experienced by various health professional groups, and then moves to an in-depth analysis of preventive strategies. The most appropriate starting point for the discussions in this chapter is with the only substantive international study of occupational violence in the health care industry ever conducted.
The previous chapter discussed the circumstances in which staff are more likely to become victims of violence. This chapter follows on by discussing the circumstances in which people are more likely to become aggressors.
In this article we introduce the concept of workplace incivility and explain how incivility can potentially spiral into increasingly intense aggressive behaviors. To gain an understanding of the mechanisms that underlie an "incivility spiral," we examine what happens at key points: the starting and tipping points. Furthermore, we describe several factors that can facilitate the occurrence and escalation of an incivility spiral and the secondary spirals that can result. We offer research propositions and discuss implications of workplace incivility for researchers and practitioners.
Aggression and violence are common in the emergency department setting. In recent years, there has been a greater recognition of this problem with State Governments in Australia responding with zero tolerance policies. This paper examines the current recommendations from nursing and medical literature with regard to the minimisation and management of aggression and violence in health care. A consistent theme throughout the literature is that early recognition and use of de-escalation strategies aimed at diffusing a volatile situation is the preferred approach. Use of restraint and a zero tolerance approach are last resort measures. It is important to have practical policies, protocols and procedures in place to manage aggression and violence in the emergency department. An emphasis on training and skill development, particularly communication and negotiation strategies, is imperative for all health care professionals.
Aggression and violence in health care professions
Although violence is increasing in most workplaces, it has become a significant problem in health care professions. Not only has the number of incidents increased but also the severity of the impact has caused profound traumatic effects on the primary, secondary and tertiary victims. More health care professionals than ever are suffering from symptoms of post-traumatic stress disorder.Addressing the problem of violence in the workplace has been exacerbated by a lack of a clear definition of what constitutes aggression and violence. As a result, some administrators have been slow to commit resources to prevent further incidents and mitigate the impact. This article describes the magnitude of the problem from both an academic research and an operational perspective. A definition is presented as an initial step towards standardizing the research, and establishing an appropriate baseline upon which intervention policies and procedures can be created. This benchmark will also help to encourage empirical research into aggression and violence in health care professions and other professions. Further research needs to be conducted to create a comprehensive instrument that can more accurately measure the range of incidents and the severity of the impact.
Workplace accidents and violence are both potential sources of employee injuries that have been dealt with in entirely separate literatures. In this study we adapted the concept of safety climate from the accident/injury literature to violence in developing the concept of perceived violence climate. A scale was developed to assess perceived violence climate, including items about management attention, concern, and policies designed to keep employees safe from violence. Data were collected from a sample of 198 nurses from a US Hospital. Perceived violence climate was found to correlate significantly with both physical violence and verbal aggression experienced by the nurses, injury from violence, and perceptions of workplace danger. Furthermore, regression analyses showed that climate explained additional variance in psychological strain and perceptions of danger over experienced violence. These results have implications for interventions aimed at producing a good perceived violence climate in order to reduce the incidence of violence and aggression within an organization. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (from the journal abstract)
In the health sector anywhere in the world, nurses make up one of the groups that are most exposed to violence such as sexual harassment, verbal abuse, and physical abuse. This descriptive study investigated the experience of verbal abuse among 339 hospital nurses in Turkey. Findings indicate that the most frequent and most severe forms of verbal abuse reported were judging and criticizing, accusing and blaming, and abusive anger; the most common emotional reactions were anger, followed by shame, humiliation, and frustration; and most nurses used engaging in negative activities to cope with verbal abuse. The results of the study suggest that hospitals must adopt zero-tolerance policies for professional verbal abuse.
Despite the majority of RNs perceiving a shortage of nurses, findings from the 2008 National Survey of RNs indicate the hospital workplace improved in several areas compared to a 2006 survey. Improvements included the time RNs spend with patients, quality of nursing care, and a decreasing impact of the shortage on delaying nurses' responses to pages or calls, staff communication, patients' wait time for surgery, and timeliness and efficiency of care. Areas the environment was perceived to have worsened included overtime hours, sexual harassment/hostile, and physical violence. RNs hold mixed views about the consequences of reporting errors and mistakes with a majority agreeing that reporting them had led to positive changes to prevent future errors, but that mistakes were held against them. Overall, results suggest that hospital managers can be reassured that their efforts to improve the workplace environment are having their intended effect but, at the same time, important areas for improvement remain.
Workplace bullying is a significant issue confronting the nursing profession. Bullying in nursing is frequently described in terms of 'oppressed group' behaviour or 'horizontal violence'. It is proposed that the use of 'oppressed group' behaviour theory has fostered only a partial understanding of the phenomenon in nursing. It is suggested that the continued use of 'oppressed group' behaviour as the major means for understanding bullying in nursing places a flawed emphasis on bullying as a phenomenon that exists only among nurses, rather than considering it within the broader organisational context. The work of Foucault and the 'circuits of power' model proposed by Clegg are used to provide an alternative understanding of the operation of power within organisations and therefore another way to conceive bullying in the nursing workforce.
This article examines the limits to which ‘inclusive’ definitions of ‘violence’ can be usefully employed. It does so within the context of research into violence, threats and intimidation experienced in the workplace by police officers and social care professionals (Accident and Emergency staff, mental health professionals, and social workers). Data were obtained from in-depth cognitive interviewing of 54 police officers and 62 social-care professionals who believed that they had recently suffered such attacks in the course of their work. What emerges is an enormously broad spectrum of behaviour that is experienced as violent, threatening or intimidating. It is argued that to stretch terms like ‘violence’ to cover such an array of experience is confusing, ultimately self-defeating and may create more problems than it resolves. The article concludes that researchers need to differentiate between episodes of ‘violence’ and suggests a set of criteria that should guide this enterprise.
The primary purpose of this study was to validate the perceptions of frequency and patterns of bullying behavior experienced by registered nurses (RNs) across the United States. This study was completed to develop relevant and sensitive tailored interventions for the future. A 30-item anonymous electronic survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying. Findings from the overall population of 303 RN respondents (mean age of 49 years) indicated that 70% of the bullying was reported by a predominant group of staff RNs (n = 212), and it is this group that is the focus of this report. Of this group, bullying occurred (a) most frequently in medical-surgical (23%), critical care (18%), emergency (12%), operating room/Post Anesthesia Care Unit (9%), and obstetrical (7%) areas of care and (b) within the 5 years or less of employment on a unit (57%). Perpetrators included senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%) who publicly humiliated, isolated, excluded, or excessively criticized the staff nurses. Subsequent stress levels were reported as moderate or severe, with support found primarily with family, colleagues, and friends and not with an available workplace infrastructure of solution. Many left the workplace completely with or without jobs awaiting them. Bullying among U.S. nurses is a hidden problem with significant patient-directed quality performance and workforce implications. It is critical that innovative strategies be developed and implemented to address the root cause of this problem.
This paper summarises what is known about bullying in the nursing workplace and approaches currently employed to address the problem. Synthesising the available evidence it is identified that restorative approaches which seek to foster shared responsibility and positively influence group norms are underdeveloped. Based upon the principles of restorative justice this approach seeks to foster active responsibility for addressing bullying by building pro-social workplace relationships. Given the importance of socialisation processes in mediating and sustaining bullying among nurses, restorative approaches are proposed as a strategy that can be employed in nursing education to address bullying.
The paper presents findings from a study examining violence in nursing.
A combined ethno-phenomenology was identified as the most appropriate approach. Ethnography is to understand the culture of nursing that permits violence to occur within the profession. Phenomenology is to explore and capture nurse-on-nurse experiences of violence. The population is all nurses registered with the South African Nursing Council. The research participants are nurses employed in eight public hospitals in Cape Town during 2005. METHOD OF DATA COLLECTION: The first stage of data collection was the distributions of confidential questionnaires to nurses employed in eight hospitals and willing to participate in the study.
Responses to close-ended questions were analyzed using Microsoft Excel. Responses to open-ended questions were grouped per question. The qualitative data were then compared for similarities and differences in information provided.
Six levels of violence exist among nurses. The highest forms of violence among nurses occurred at the psychological level, with the least at the physical level of interaction. The other four levels of violence among nurses were vertical, horizontal, covert, and overt. All categories of nurses in the study had resorted to one or more levels of violence against other nurses during their nursing career. Professional nurses and senior nurse managers were identified as the main category of nurses that frequently resort to mistreating other nurses. However, auxiliary nurses were identified as the main perpetrators of physical violence against other nurses.
Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.
Workplace violence is one of the most complex and dangerous occupational hazards facing nurses working in today's health care environment. This article includes critiques of the conceptual, empirical, and policy progress of the past decade, a discussion of the need for methodologically rigorous intervention effectiveness research, and a description of a joint-labor management research effort aimed at documenting a process to reduce violence in a state mental health system. The development of a typology of workplace violence has advanced our understanding of the relationship of the perpetrator of the violence to the victim and provided a foundation for conceptual frameworks linking etiology and prevention. Even though health care workers may be exposed to four types of violence in the course of their work, the overwhelming majority of threats and assaults against caregivers come from patients (Type II), justifying emphasis on this type of violence. Individual nurses and direct care providers have very little influence over the level of violence in their workplaces, but through collective action are poised to influence policies designed to protect the health care workforce.
This article examines the nursing literature on workplace bullying with the aim of reaching a better understanding of the phenomenon.
Workplace bullying occurs in many occupations and workplaces, including nursing.
The following databases were used for the literature review: CINAHL, PubMed, Pro Quest and EBSCO host. Only articles in English were used. Articles from outside the nursing literature were also examined to gain a broader understanding of workplace bullying.
Workplace bullying is more than a simple conflict between two individuals. It is a complex phenomenon that can only be understood through an examination of social, individual and organizational factors. Workplace bullying has been shown to impact the physical and psychological health of victims, as well as their performance at work. Workplace bullying impacts the organization through decreased productivity, increased sick time and employee attrition.
More nurse-specific research is needed in this area. Research needs to be conducted in a systematic and uniform manner so that generalizations across studies can be made. The ultimate goal of this research should be to generate an understanding of this phenomenon so that solutions can be found.
Violence, harassment, and bullying in the workplace are not new phenomena. However, the growing epidemic of violence in the health sector workplace is raising great concern among workers, employers, and governmental agencies across Australia, Canada, the United Kingdom, and the United States. National and international literature reveals that the prevalence of violence experienced by graduate and undergraduate female nursing students in the college and workplace settings is largely unknown. Moreover, the prevalence of violence is now recognized as a major health priority by the World Health Organization, the International Council of Nurses, and Public Services International. Even so, the number of nursing personnel affected by this problem continues to rise. A modified self-report online survey was used to ascertain the level of violence experienced by nursing students in their clinical placements. One hundred percent of those surveyed had experienced some type of workplace violence and the perpetrators were most often other staff members followed closely by patients. The American Association of Colleges of Nursing Position Statement recommends that all faculty prepare nurses to recognize and prevent all forms of violence in the workplace. This research seeks to develop practical approaches to better understand and prevent this global public health issue.
The U.S. health care system is in the beginning of a crisis that can barely be comprehended. If projections are accurate, the demand for nurses will increase 40% and a 400,000-hour full-time equivalent registered nurse shortfall will occur by 2020. Not only are nurses leaving the field, but fewer candidates are entering. The reasons are unclear, but research has shown that nursing is a dangerous occupation--four times more dangerous than most other occupations. Protection from an unsafe workplace is guaranteed under Occupational Safety and Health Administration regulations, and many national and international groups call for zero tolerance of workplace violence. Health care worksites must develop specific plans to minimize and prevent workplace violence. Additional research is necessary to determine which methods are most effective. This article examines the necessary components of a workplace violence prevention program.
The nursing profession has one of the highest assault risks. Managing patient aggression is therefore a challenge for nurses, especially for nursing students. This longitudinal pre-post-test study set out to test the outcome of a training course tailored to the special needs of nursing students on their confidence in coping with patient aggression.
Sixty-three nursing students in four groups attended three-day training courses designed specially to meet their needs. Thackrey's confidence in coping with patient aggression scale was used before the training, immediately after the training, and after two weeks in practical placement. Questionnaires about perceived changes were completed two weeks into practical placements and were analyzed by qualitative content analysis.
A significant enhancement of students' self-reported confidence in dealing with patient aggression was found. The overall mean score changed significantly from 2.5 in the pre-test to 3.6 after the training. No significant decrease in the score was found after two weeks in the practical placement. Regarding managing aggression almost half of the students became aware of perceived changes in daily practice.
The three-day training course is able to support nursing students' self reported capacities to manage patient aggression.
In a climate of a declining nursing workforce where violence and hostility is a part of the day-to-day lives of most nurses, it is timely to name violence as a major factor in the recruitment and retention of registered nurses in the health system. Workplace violence takes many forms such as aggression, harassment, bullying, intimidation and assault. Violent acts are perpetrated against nurses from various quarters including patients, relatives, other nurses and other professional groups. Research suggests that nurse managers are implicated in workplace violence and bullying. Furthermore, there may be a direct link between episodes of violence and aggression towards nurses and sick leave, burnout and poor recruitment and retention rates. This paper explores what is known about workplace violence as it affects nurses, and calls for managerial support and policy to act to improve work environments for all nurses.
Self-esteem is a major predictor of behaviour. Nurses with healthy self-esteem are likely to deliver therapeutic patient care, while those with low self-esteem are less likely to do so.
The aim of the 3-year study discussed here was to explore students' self-esteem and how their experiences of preregistration education influenced its development over the period of the programme.
Students participated in unstructured qualitative interviews at the beginning and end of their 3-year preregistration course and a grounded theory approach was used for data collection and analysis.
Bullying was found to be commonplace in the transition to becoming a nurse. Students were bullied and also witnessed patients being bullied by qualified nurses. The internalization of nursing norms meant that students then bullied others. Students' self-esteem was low.
Bullying, and its effects on self-esteem, are perpetuated by practices within nursing. This situation will only be changed if nurses and educators transform their practice and the context in which bullying occurs. Otherwise, each new generation of nurses will continue to be socialized into negative practices which undermine both their own feelings of self-worth and standards of nursing care.
To describe the experience of verbal abuse in a large multihospital system and determine the relationship of verbal abuse with intent to leave the organization.
Descriptive correlational design using mailed questionnaires.
Randomized sample of 1000 nurses received questionnaire; 46% response rate, with a final useable sample of 461 surveys.
Of the respondents, 91% had experienced verbal abuse in the past month. The physician was the most frequent source of verbal abuse, followed by patients, patient families, peers, supervisors, and subordinates. More than 50% of the sample did not feel competent in responding to verbal abuse. Amount of abuse and intent to leave were significantly related (r = .211, p < .01).
Organizations must adopt zero-tolerance policies for professional verbal abuse. Education and coaching are needed to help nurses to improve their skills when responding to patient-to-nurse and professional-to-professional verbal abuse.
Workplace violence is acknowledged as a major problem in health care settings and affects staff morale, recruitment, retention and direct health care budgets. Staff training is advocated as the appropriate managerial response, but identifying appropriate training and trainers is difficult and there is little published evidence of training effectiveness. Student nurses are frequent targets of aggression but are less likely to receive specific training.
The study considered the application of a model of learning to a 3-day learning unit for diploma-level student nurses on the "prevention and management of aggression". It aimed to measure student outcomes of the unit and gain information about more general issues in evaluating training effectiveness.
A repeated measures longitudinal design was used to obtain data from three cohorts of student nurses (3 x 80 approximately) at four time points over an 8-month period. A questionnaire was administered twice before the unit, at its conclusion and approximately 3 months afterwards, following two clinical placements.
Statistically significant changes were demonstrated in a number of areas, including number of risk factors identified, and five "factors" identified from the questionnaire statements.
The results refer to one course for student nurses that had many common elements with popular training courses for qualified staff, including inter-personal and breakaway skills. However, restraint skills were not included.
It is possible to provide training that produces desirable, statistically demonstrable and durable change in knowledge, behaviour, attitudes and confidence using a rigorous longitudinal evaluation research design.
Recent literature defines lateral violence as nurses covertly or overtly directing their dissatisfaction inward toward each other, toward themselves, and toward those less powerful than themselves. Newly licensed nurses are an identified group that is vulnerable to lateral violence during their socialization to nursing practice. The use of cognitive rehearsal, an applied cognitive-behavioral technique, was used as an intervention and the theoretical underpinning for this study.
Twenty-six newly licensed nurses hired by a large acute care tertiary hospital in Boston, Massachusetts, participated in an exploratory descriptive study. They were taught about lateral violence in nursing practice and the use of cognitive rehearsal techniques as a shield from the negative effects of lateral violence on learning and socialization. Small laminated cueing cards with written visual cues for the appropriate responses to the most common forms of lateral violence were provided. One year later, videotaped focus groups designed to collect qualitative data about the applied intervention were conducted.
Twenty-six newly licensed nurses in three different focus groups were videotaped responding to six open-ended questions designed to elicit information on their experience with lateral violence, use of cognitive rehearsal as an intervention, and the overall socialization process.
Knowledge of lateral violence in nursing appeared to allow newly licensed nurses to depersonalize it, thus allowing them to ask questions and continue to learn. The learned cognitive responses helped them confront the lateral violence offender. Confrontation was described as difficult but resulted in the resolution of the lateral violence behavior. Overall, the retention rate in this study population was positively affected.
The purpose of this study was to explore the types and frequency of verbal abuse of nurses by other nurses. Further, this study explored the components, characteristics, consequences and effects of abuse in an effort to better understand the dynamics of verbal abuse of nurses in the workplace. Nurses who experience occupational burnout are more likely to abuse other nurses.
It is believed that nurses have been historically subjected to verbal abuse by colleagues, something previously considered to be done primarily by doctors. The effects and consequences of verbal abuse can be devastating and long-lasting. Research that has focused on its consequences has found that it is both physiologically and psychologically damaging.
Participants completed an adapted survey, incorporating the Verbal Abuse Scale and the Verbal Abuse Survey and demographic questions developed by the researchers. Specifically, types of verbal aggression, the frequency and stressfulness of each type, emotional reaction to verbal aggression, cognitive appraisal of verbally aggressive encounters, and similarity and effectiveness of coping behaviours were explored. The long-term negative effects of verbal aggression, including absenteeism and errors in patient treatment, were also evaluated to determine if verbal aggression is a contributing factor.
Respondents reported that the most frequent source of abuse was nurses (27%), followed by patients' families (25%), doctors (22%), patients (17%), residents (4%), other (3%) and interns (2%). Of those who selected a nurse as the most frequent source, staff nurses were reported to be the most frequent nursing source (80%) followed by nurse managers (20%).
Verbal abuse in nursing is quite costly to the individual nurses, the hospitals and the patients. Nurses who regularly experience verbal abuse may be more stressed, may feel less satisfied with their jobs, may miss more work and may provide a substandard quality of care to patients.
This paper reports a study of staff and patient perspectives on the causes of patient aggression and the way it is managed.
The incidence of aggression in healthcare is reportedly on the increase, and concerns about the management of this problem are growing.
A convenience sample of 80 patients and 82 nurses from three inpatient mental healthcare wards were surveyed using The Management of Aggression and Violence Attitude Scale. A further five patients and five nurses from the same sample participated in a number of follow-up interviews.
Patients perceived environmental conditions and poor communication to be a significant precursor of aggressive behaviour. Nurses, in comparison, viewed the patients' mental illnesses to be the main reason for aggression, although the negative impact of the inpatient environment was recognized. From interview responses, it was evident that both sets of respondents were dissatisfied with a restrictive and under-resourced provision that leads to interpersonal tensions.
There are differences between the views of staff and patients about reasons for aggression and its management. Future approaches therefore need to be developed that address these opposing views. For example, training in the use of fundamental therapeutic communication skills was advocated by patients, whilst the need for greater attention to organizational deficits was advocated by nurses. A move away from reliance on the use of medication was also felt to be necessary. Evaluation of local needs and practices must be an integral part of this process.
This descriptive study investigated the experience of verbal abuse among a voluntary sample of registered pediatric nurses working in six hospitals in Eastern Ontario (N=35), over a six week period. Roy's Adaptation Model was used as the conceptual framework for this study. A questionnaire was used to ascertain the incidence, source, level of reporting, and personal and professional reactions of verbal abuse in this specific population. Analysis and treatment of data included descriptive statistics and Spearman Correlation tests. Pediatric nurses were the frequent victims of verbal abuse. Patients, parents/visitors, and physicians were equally ranked as the most common perpetrators. There was distinct lack of reporting of verbal abuse. Reasons reported included (a) the incident was not important enough, and (b) the situation was handled/resolved. An increase in stress level and decreased job morale were among the most frequently perceived personal and professional reactions of verbal abuse.
Violence is an issue that is attracting increasing attention in the nursing literature. There is general agreement that nurses are exposed to unacceptable levels of violence and aggression in the workplace, and that levels of violence are increasing. Despite this attention and awareness, however, violence does not have a standard definition, and theoretical explanations of violence are seldom considered when discussing it in relation to nursing. This paper discusses current issues associated with defining violence, and presents an overview of some of the traditional and contemporary theories of aggression and violence in relation to nursing and the health context. Conflicting issues surrounding predictors and precipitators of violence are examined. We explore the notion that violence is 'part of the job' in nursing. In conclusion, we assert that the current discourses on aggression and violence maintain the status quo, and argue that new explanatory positions on aggression and violence towards nurses are needed.
The purpose of this research was to examine the incidents of verbal abuse faced by nurses in the workplace in the last year. Data were collected from 290 hospital nurses in Turkey. The study found that the majority of nurses had faced verbal abuse (n = 233, 80.3%). The findings from the research confirm the need for urgent and continuous plans for addressing verbal abuse in the workplace and for adoption of zero tolerance.
This commentary paper highlights the every day reality for nurses facing episodes of violence and aggression while working in the health care system in Western Australia and identifies future research necessary to address the problem. Nurses, in a range of work environments, face the terrifying possibility of being victims of aggressive and violent incidents while caring for patients. The consequences of these events are far reaching and include an increased cost to the health care system, loss of experienced nurses from the workforce and the inability to attract nurses back to the bedside. Although the West Australian government has attempted to address the problems with quick fixes, no current initiatives have been effective and nurses are still experiencing assault in ever increasing numbers. To ensure that nurses stop being the victims of these events it is essential that nurses, government and the community refuse to accept that violence and aggression are 'just part of the job'. Sound research is important in raising awareness and providing direction for hospital policy and practice. Furthermore, future research in the area has to investigate the phenomenon as a whole taking into consideration all aspects of these events. The results of this research must then form the framework for future education programs, policies and best-practice guidelines for safety of nurses and ultimately patient care.
The possibility that nurses exhibit oppressed group behaviors was first broached by Roberts [Roberts, S. J. (1983). Oppressed group behavior: Implications for nursing. Advances in Nursing Science, 21-30] when Freire's model [Freire, P. (1970). Pedagogy of the oppressed. New York: Herder and Herder] was applied to nursing. Since then, scholarly discussion has focused on aspects of oppression in nursing, but little research toward validation of Freire's model has occurred. An extensive literature search in CINAHL was completed seeking exploration and validation of the oppressed group behavior model and its dimensions. The Educational Testing Services, PsychInfo, Health and Psychosocial Instruments, and Sociological Abstracts databases were searched for measurement tools created within the last 10 years. This literature review identified that a model of oppressed group behavior has not been developed and validated, and that oppressed group behaviors have been studied independent of each other; however, oppressed group behaviors may have implications for the current nursing shortage.
Horizontal violence is a significant issue confronting the nursing profession both in Australia and internationally. The term horizontal violence is used to describe bullying and aggression involving inter-group conflict. Some evidence suggests that nursing students commonly experience this during clinical placement(s). Despite the current shortage of nurses and the fact that clinical placement experiences may influence whether students remain in the nursing profession, there has been little research undertaken on this topic. This study used a questionnaire to investigate 152 second and third year nursing student's experiences of horizontal violence (either directly experienced or witnessed). Analysis identified five major themes: humiliation and lack of respect; powerlessness and becoming invisible; hierarchical nature of horizontal violence; coping strategies; and future employment choices. More than half of the sample indicated that they had experienced or witnessed horizontal violence; importantly, most of these (51% of the total sample) also indicated that it would impact on their future career and/or their employment choices. Strategies are discussed that could be implemented to reduce the effect of horizontal violence, including giving a higher priority to debriefing within a supportive university environment, and teaching assertiveness and conflict resolution skills within the Bachelor of Nursing Degree.
Workplace violence is of great concern to all health care professionals. Nurses are major targets for incidents of violence, with student nurses being clearly recognised as a high-risk sub-group. Training is widely advocated as the appropriate organisational response but the effects and effectiveness of training are inadequately studied. A recently completed Ph.D study used a longitudinal research design to evaluate the effects of a three-day 'aggression prevention and management training programme' on various learning domains of three cohorts of UK student nurses destined for adult, child, mental health and learning disability specialities [N=243] in their first year of nurse training. A purpose-designed questionnaire was used to collect data on knowledge, attitudes, confidence, and self-assessed competence at four time points, two before and two following the educational input. This paper focuses on the differences detected in student nurses' responses to different sections of the questionnaire, at various time points, in relation to recorded demographic variables, namely, their age, gender, destined speciality, and previous relevant training experience. It also considers the 'interaction' between theoretical preparation and clinical practice. These finding may also have wider relevance to skills training and understanding of the reality of student nurse experience in clinical settings.
Incivility and bullying in the workplace are intimidating forces that result in shame responses and threaten the well-being of nurses. Some nurses are accustomed to tolerating behaviors that are outside the realm of considerate conduct and are unaware that they are doing so. These behaviors affect the organizational climate, and their negative effects multiply if left unchecked. Interventions for incivility and bullying behaviors are needed at both individual and administrative levels. © 2008, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
The purpose of this study was to examine incivility experienced by direct health care staff in their workplaces. The sample (N = 184) was 91% female and 77% White, with 71% of the participants having earned an associate degree or above and 81% being registered nurses. The Work Limitations Questionnaire and the Incivility in Healthcare Survey were distributed to all direct care staff at a major metropolitan hospital (22% response rate). Correlations were found between workplace incivility from direct supervisors and productivity (r = 0.284, p = .000) and workplace incivility from patients and productivity (r = 0.204, p = .006). Incivility from physicians, incivility from other direct care staff, and general environmental incivility were not shown to be significantly related to productivity. Demographics were not related to levels of workplace incivility. Workplace incivility from patients and management appears to have a greater impact on employees' productivity than workplace incivility from other sources.