Christianah Adeyeye Violence in nursing

Objectives To understand the definition of workplace violence and the types of workplace violence How to prevent workplace violence and what actions to take when violence happens To learn about lateral violence, how it affects nursing, and how to address it

Question: What is your definition of workplace violence?

What is Violence? U.S. Occupational Safety and Health Administration (OSHA) and U.S. Centers for Disease Control (CDC), defines workplace violence as “violent acts” (including physical assaults and threats of assaults) directed toward persons at work or on duty (McPhaul & Lipscomb, 2004).

Types of Workplace Violence Type I- (Criminal Intent) Criminal activity is being committed and the perpetrator has no legitimate relationship to the workplace Type II- (Customer/Client) Perpetrator is a customer or client at the workplace and becomes violent while being served by the worker

Types of Workplace Violence Cont’d Type III- (Worker on Worker) Employees or past employees of the workplace are the perpetrators Type IV- (Personal Relationship) Perpetrator usually has a personal relationship with an employee (McPhaul & Lipscomb, 2004)

Question: Where do you think workplace violence typically occur?

Where does violence typically happen? Emergency Departments Mental Health and Psychiatric Units Nursing Homes, Extended Care Facilities Home and Community Health (McPhaul & Lipscomb, 2004).

Risk for Violence in Hospitals Working directly with volatile people drugs and alcohol history of violence certain psychotic diagnoses Working when understaffed Transporting patients Long waits for service Overcrowded, uncomfortable waiting rooms

Risk for Violence in Hospitals cont’d Poor environmental design Lack of cameras, good lighting, security devices Inadequate security Lack of staff training and policies for preventing and managing crisis with potentially volatile patients (McPhaul & Lipscomb, 2004).

How to diffuse or deescalate an angry client/patient Present a calm, caring attitude Don’t match the threats Don’t give orders Acknowledge the person’s feelings Ex. “I know you are frustrated” Avoid any behavior that may be interpreted as aggressive Ex. moving too rapidly, getting too close, speaking loudly, touching Centers for Disease Control (www.cdc.gov).

What should a victim do when violence happens Remove yourself from the situation! File a criminal report with the police Don’t be silent; speak about what has happened to managers and coworkers Photograph any injuries Work with hospital administrators and union representatives to formulate procedures Ask witnesses to document what they saw Be cautious with patients that have history of violence (American Journal of Nursing, 2007).

What are the consequences of work related violence? Jeopardizes patient care Nurses suffer posttraumatic stress disorder, poor work performances, sleeping difficulties, and family disruption Feel unsupported by management Can cause nurse burnout as well as poor recruitment and retention (Hong Kong Medical Journal, 2006).

Ways to prevent violence in the workplace Providing specially trained security staff for high risk situations Training in techniques for reducing aggression Improvement in environmental design such as lighting, metal detectors, mirrors, alarms (McPhaul & Lipscomb, 2004)

Lateral/Horizontal Violence Used to describe the physical, verbal, and emotional abuse of an employee. It can be defined as nurse to nurse aggression In extreme form, lateral violence can manifest itself as bullying. Bullying is defined as a conscious, willful, deliberate, hostile activity intended to harm, induce fear through threat of further aggression, and to create terror (Sincox & Fitzpatrick, 2008).

Lateral Violence- Common Forms Nonverbal innuendo Fault finding Verbal affront Segregation Undermining actions; unavailability Isolation Unwarranted criticisms Withholding information Inequitable assignments Sabotage; “setting up to fail” (Sincox & Fitzpatrick, 2008). Backstabbing Broken confidences

Frequent targets of lateral violence Nursing students Newly licensed nurses/ newly hired nurses Temporarily assigned nurses Float nurses Nursing assistants/aides

Physiological and Psychological Symptoms Headache Fatigue Stomach disorders Conflicts in intimate relationships Weight changes Engage in substance abuse and experience social isolation Hypertension Stress Anxiety Panic (Sincox & Fitzpatrick, 2008). Embarrassment Depression

As a result of lateral violence… According to the Lateral Violence article by Sincox and Fitzpatrick, 60% of nurses new to practice leave their positions within the first six months because of lateral violence against them. Frustration and dissatisfaction contributes to decreased organizational commitment, increased staff turnover and nursing shortage which can affect the quality of care and negatively impact patient satisfaction (Sincox & Fitzpatrick, 2008).

Calling attention to lateral violence The organization and the unit must have a policy of zero tolerance towards violence and bullying. Blame free, reprisal-free treatment of employees Interrupt the violence- address it early Keep accurate records to help document and track the problem Face lateral violence by technique called cognitive rehearsal

Cognitive Rehearsal Cognitive rehearsal is based on cognitive behaviors. Cognition is a mental characteristic which requires the obtaining, organizing and using of intellectual knowledge. Cognitive rehearsal is a technique using cognition that asks the individual to hold in their mind information that they have just received. During this time, the individual has the opportunity to process the information, and “ponder it” rather than responding immediately. (Rowell, 2007).

Suggestive ways to stop lateral violence According to Sincox and Fitzpatrick, nurses must take measures to deal with the problem so it won’t be passed on to future nurses Nurse educators and executives setting an example of respectable behavior Hold individuals accountable for respectful behavior in the workplace and clinical environment Staff nurses must be empowered to speak out and support other nurses than ignoring the situation Have formal education classes to address the issue and change norms of lateral violence

Question: Do you think that nursing schools should incorporate formal classes about lateral violence into the curriculum?

Violence… (Select all that applies) A: is part of the job of nursing, if a nurse got hit, she/he deserved it B: can be prevented by use of security, training classes, and environmental designs C: is not part of the job of nursing D: in healthcare is the leading sector of workers that has the highest rates of non- fatal assault injuries in the workplace

A: Yell back at the patient B: Order the patient to return to his room A patient that has a history of violence approaches you at the nurses station yelling at you, You as the nurse would: A: Yell back at the patient B: Order the patient to return to his room C: Reply back to the patient in a calm, caring voice and find out what the problem is D: Ignore the patient

A: Talk about her among the other nurses B: Deal with it A nurse who worked a shift before you is disorganized which irritates you because it affects your job. What action would you take? A: Talk about her among the other nurses B: Deal with it C: Confront the nurse about it D: Go straight to the DON

A: Respond using profanity words B: Lash back out to the nurse A nurse lashes out on you regarding your opinion about an issue on the unit. You should… A: Respond using profanity words B: Lash back out to the nurse C: Use cognitive rehearsal to hear what she had to say, and respond in a non-judgmental, non-argumentative tone

This weekend I’m going to… (Select all that applies) A: Study, Study, Study B: Go out on a hot date, tomorrow is sweetest day C: Go costume shopping for Halloween D: Work E: Relax F: None of the above

References (2002). Violence occupational hazards in hospitals. Retrieved from http://www.cdc.gov/niosh/docs/2002-101/ (2006). Preventing workplace violence. American Nurses Association. (2006). Violence in the health care workplace. Hong Kong Medical Journal, 12(1), 4-5. (2007). Violence and nursing. American Journal of Nursing, 107(2), 25-26. (2008, April). Lateral violence in the workplace [Video Podcast]. You Tube. Retrieved from http://www.youtube.com/watch?v=mBCRBaLHR1k (2008, February). Nurses confront violence on the job [Video Podcast]. You Tube. Retrieved from http://www.youtube.com/watch?v=chkOM058U2E McPhaul, K.M., & Lipscomb J.A. (2004). Workplace violence in health care; recognized but not regulated. The Online Journal of Issues in Nursing, 9(3), Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Table ofContents/Volume92004/No3Sept04/ViolenceinHealthCare.aspx Rowell, P.A. (2007). Lateral violence: nurse against nurse. Retrieved from http://www.nursingworld.org/mods/mod440/lateralfull.htm Sincox, A.K., & Fitzpatrick M. (2008). Lateral violence: calling the elephant in the room. Michigan Nurse, Retrieved from http://www.minurses.org/news/MN2008/0506mn/0506mn_lateralviolence.pdf