Workplace Violence Experienced By Nurses

Violence in the workplace is on the rise, especially in hospitals and medical care facilities. The United States Department of Labour defines workplace violence as “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behaviour that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors” (2017). Nurses are experiencing abuse or attacks from their patients daily, and unfortunately their experiences are causing nurses to rethink their whole career choice. The job of a nurse is to care, heal, listen, comfort, clean and promote the health of their patients. However, the rise of patient to nurse violence is forcing many nurses to either take time off work, take stress leave, or even quit their job. The aftermath of the problem is causing major stress, anxiety, and in some extreme cases post-traumatic stress disorder, that can bleed into all parts of the nurses life. Whether that be their job, family, social life, relationships or their health. As a self regulatory body, nurses must come together to stand up for their rights and take initiative to create a change in their work environments and dynamics. It is important for a nurse to feel safe and respected in their place of work and if that is not happening, it is their responsibility to speak out and vocalize the issue. Violent encounters in the workplace can affect all aspects of a nurses life, which can be corrected by implementing procedures to prevent violence and better care for post-traumatic events.

Causes of Violent Attacks

Each location that a nurse works in has it challenges; some more than others. It was discovered that a nurse who works in a mental health facility will endure more severe work-related stress and anxiety than that of a nurse who will work in a general hospital. As these nurses are exposed to much more recurring violent encounters with patients, the stress levels increase dramatically (Itzhaki, Peles-Bortz, Kostistky, Barnoy, Filshtinsky & Bluvstein, 2015). Mental health is such an important area of care in nursing and unfortunately it has the highest amounts of patient to nurse violence. However, not every patient understands their actions as the mental illness they are experiencing can cloud their mind and judgement. Several factors that contribute to patient aggravation include the living conditions, crowded rooms, and the atmosphere of the hospital and staff (van Wijk, Traut, & Julie, 2014). Bright lights and loud noises of a busy hospital can make sleep an impossible goal for some and the lack of sleep can cause irritation and outbursts from patients. The food in hospitals can be a shock as well as they might be used to much different meals. For example, the food could be cold, or brought at an unusual time to the patient. Many patients feel irritation when the staffing is low and they don’t feel like anyone is paying attention to them, their personal space is being invaded when their is a lack of privacy for them, or when their care plan calls for intimate and close physical touch (Potter et al, 875). Another big issue within hospitals is the disrespect of a patients culture, religion, or economical background. This behaviour, when exhibited by the staff, is frustrating and can anger any patient involved. Some patients may view a nurses tactic of inquiring information as intruding and rude even though that was not the nurses intention. All of these factors can contribute to making a violent attack of any kind seem rational to a patient.

Consequences of Violence

Nurses experience many different kinds of violence at work. The word ‘violence’ is usually thought of as a physical attack on someone, however, this is not always the case. These encounters experienced by nurses can include physical abuse, verbal abuse, emotional or mental abuse, sexual and even cultural abuse. Each type and each experience whether it is big or small, can have major emotional effects on the nurse. One form of violence is physical attacks, which includes hitting, kicking, pinching and more. There are many consequences of physical violence for the nurse that “include acute stress, post-traumatic stress symptoms, decreased work productivity, physical injury, and death” (Gillespie, Gates, Berry, 2013). These consequences invade the nurses life in many different ways. Nurses have to work hard every day. For example, moving patients to and from the bed, or being on their feet for twelve hour shifts can increase the chance of physical injury thus, restricting what they can do. These injuries, depending on the intensity of the attack, can range anywhere from a bruise, sore limb, cut or skin puncture, to a broken or dislocated bone. Feeling scared to go to work, scared of physical touch from their friends or family, embarrassment from injury; the aftermath of a physical attack from patient to nurse at work can be vicious and traumatic. Each consequence of experiencing any kind of traumatic event bleeds into a nurses ability to manage with their daily activities. The International Journal of Nursing Studies defines a traumatic event as, “a situation that is so extreme, so severe and so powerful that it threatens to overwhelm a person’s ability to cope” and these events will ensue in reactions that are so overwhelming and can influence their emotions, actions, or thoughts (Adriaenssens, de Gucht, & Maes, 2012). Research has proven that when a nurse is stressed out, their overall health and performance of their job is worse than if they were not stressed (Chana, Kennedy, & Chessell, 2015). Change must occur, and the nursing community has so many options to educate and influence the actions of nurses, so that they can feel empowered when these violent scenarios do occur.

Code of Ethics Application

Within the issue of patient to nurse violence, the Canadian Nursing Association Code of Ethics supplies nurses with various ways to approach change and a way of practice that benefits both the nurse and patient. Ethical practice can have influence on the patient in so many different ways, as there are several ways that a nurse can do so. Each area of topic in the Code of Ethics applies to this issue and should be intertwined into education of nurses on violence prevention. Compassionate care can be applied to all situations to prevent any further irritation of the patient. Listening and hearing the struggle or story of the patient is an excellent way to let them know that you understand their problems and from there, nurses can do what they can to improve the situation. Research is a valuable way to determine how to solve a problem. The Code says that nurses should “support, use and engage in research and other activities that promote safe, competent, compassionate and ethical care.” Research is a vital part of all problem solving and within an issue that happens every day and to different levels of severity, it can be incredibly beneficial to improving the level of stress and anxiety to nurses. Studying the environments that violent encounters happen in allows for nurses to better understand how prevention of violence can be done successfully. Another point of ethical care is to give every patient respect with regards to their personal values, cultural customs, religion or spiritual beliefs, and their social and economic background with no judgment or bias. This is incredibly helpful in prevention for violet attacks because many patients feel neglected in a busy hospital, so to taking the time to listen and respect their wishes is a powerful persuasion tool. It influences the patients to see that their nurse wants to include their thoughts and feelings into their medical care and that they will respect and not judge the patients decisions.

Fraser Health Authority

The Fraser Health Authority has programs implemented within the education programs in which it has students practicing in. They provide and make it mandatory for students to partake in learning modes to educate and further their knowledge in violence prevention. The modules are very informative and help the students in various ways. These students will then have the competence to handle a situation properly. As employers, Fraser Health can provide a safe workplace for all of their staff, they can put incentives in for de-escalating an issue, provide therapeutic support to nurses who have experienced a violent encounter, create a culture of respect to the patients and nurses, and they can create an open and supportive environment for nurses to report incidents. It is vital for the nurse to report and document any and all incidents because it helps in dealing with the patient and what measures to use the next time something similar may occur.

TWU Philosophy of Nursing

Trinity Western University’s Philosophy of Nursing is based upon holistic care which is described as the “intimate connection between body, mind, and spirit” ( M.E. Obrien., 2018). Caring for a person in more than just a physical sense, but in their thoughts and their spiritual wellness. Trinity Western has every student take core classes to better educate them as a whole person who can think and look through the perspective of numerous different approaches of learning. The core classes teach the students to advance themselves in all aspects so they can better understand other people as well. When a nurse can understand the patient, it allows them to connect and create a bond between patient and nurse. This is a helpful solution to the violent issue because when a connection is made the patient will feel less inclined to harm someone who is caring for them and who wishes to better the patient in a holistic way. Mental health awareness is on the rise and using a holistic approach to care is an amazing way to show the patients that we as nurses care for them as a whole person, and not as just a disease.

BCCNP Practice and Professional Standards

The BC College of Nursing Professionals professional standards are to “explain what nursing is and what nurses do” and “advocate for changes to policies and practices.” (BCCNP) Nurses must be responsible and accountable for their actions, including making sure that their well being is good enough to continue working. This action will help the issue as competent care for patients and a clear mind will help the nurse provide the best care possible, and the patient will feel the connection with their nurse. The standards are there to provide nurses with opportunity and ground to speak up about changes that must be made in the workplace, such as violent encounters from patient to nurse. It is so important that nurses use these standards to understand where they can make change about their own job performance, and where they can stand up and show where a problem is occurring.

Conclusion

In conclusion, violence from patient to nurse is an incredibly big issue and a change in the actions of prevention and post-traumatic care must be made. Nurses are facing extreme stress and anxiety from workplace violence and it is causing their work performance to decrease. Patients can become irritated from several different sources inside and outside of the hospital, influencing nurses to seek out what is wrong and alter what is needed to improve the stay of their patients. The Canadian Nurses Association says that, “health care professionals are at the highest risk for bing attacked at work” and so there is major cause for nurses to be advocates for the improvement of their workplace and well-being (2018). Nurses have several different associations, professional bodies, and health authorities to go to for more information and help when it is needed. The more research, documentation or reporting of violent encounters will dramatically help end and change violent patient to nurse attacks.