Healthcare workers are prone to workplace violence from external and internal parties. Because nursing represents the most extensive portion of healthcare workers in the United States, nurses are disproportionately vulnerable to violence attributable to patients. Patient violence is an endemic occupational hazard with significant effects on nurses, patient care, and organizational performance. Nurses working in unsafe may encounter physical injuries, sexual assaults, and verbal abuse, increasing the risk of developing emotional distress and psychiatric disorders. Patient violence is also a precursor to suboptimal staff productivity, job dissatisfaction, and high employee turnover. It hinders effective nurse-patient relationships, reducing the quality of therapeutic communication. The overall effect of patient violence has consequential implications to the nursing profession, patient care, and workplace safety, highlighting the need for comprehensive measures to subdue violence incidence in healthcare settings.
Although the American Nurses Association (ANA) advocates for zero-tolerance of "incivility, bullying, and workplace violence," inadequate incidence reporting mechanisms limit the ability to nurture staff safety. Some staff members may dismiss covert and overt aggressiveness attributable to patients with problematic behaviors and, unfortunately, propagate unsafe working situations. Thus, effective incidence reporting policies are instrumental in promoting mitigating violent encounters from patients or their family members.
Abstract
Healthcare workers are prone to workplace violence from external and internal parties. Because nursing represents the most extensive portion of healthcare workers in the United States, nurses are disproportionately vulnerable to violence attributable to patients. Patient violence is an endemic occupational hazard with significant effects on nurses, patient care, and organizational performance. Nurses working in unsafe may encounter physical injuries, sexual assaults, and verbal abuse, increasing the risk of developing emotional distress and psychiatric disorders. Patient violence is also a precursor to suboptimal staff productivity, job dissatisfaction, and high employee turnover. It hinders effective nurse-patient relationships, reducing the quality of therapeutic communication. The overall effect of patient violence has consequential implications to the nursing profession, patient care, and workplace safety, highlighting the need for comprehensive measures to subdue violence incidence in healthcare settings.
Although the American Nurses Association (ANA) advocates for zero-tolerance of "incivility, bullying, and workplace violence," inadequate incidence reporting mechanisms limit the ability to nurture staff safety. Some staff members may dismiss covert and overt aggressiveness attributable to patients with problematic behaviors and, unfortunately, propagate unsafe working situations. Thus, effective incidence reporting policies are instrumental in promoting mitigating violent encounters from patients or their family members.
An effective solution to patient violence warrants a systematic, evidence-based intervention to promote awareness and equip staff members with appropriate skills for deescalating and diffusing tense encounters with patients. This approach encourages multidisciplinary support and the effective distribution of security resources to address specific patient violence triggers or risk factors in different nursing units. To this end, this capstone project aims to address patient violence against nurses, identify potential barriers, and EBP intervention plan for reducing the risk of WPV in nursing practice. It proposes to assess staff perceptions toward patient violence and reporting mechanism in nursing practice. This aims to identify risk factors influencing patient violence against nurses and policy improvement opportunities. After its completion, this project anticipates promoting staff awareness about patient violence and make EBP policy recommendations for improving incident-reporting procedures. The capstone’s ultimate goal is to enhance staff safety by reducing the risk and prevalence of patient violence in nursing practice.
Preventing Patient Violence against Nurses
Healthcare workers face multiple occupational threats, such as patient violence in hospital environments. Workplace violence (WPV) occurs when a healthcare worker is threatened, abused, assaulted, or injured by a patient in their place of work. Other forms of WPV involve psychological, sexual, and physical assaults. WPV orchestrated by patients and patient visitors pose significant occupational hazards in nursing practice. Patient violence threatens staff safety, decreases productivity and job satisfaction. It causes emotional distress and psychiatric disorders in staff members, affecting their ability to deliver quality and safe healthcare services (ANA, 2019; Arnetz et al., 2017). WPV caused by patients negatively affects staff retention, job satisfaction, and patient care outcomes. Besides, inadequate patient violence incident reporting mechanism limits hospitals from developing effective evidence-based interventions to curb patient violence.
Description of the Problem
Workplace violence (WPV) is an endemic occupational hazard facing healthcare professionals. In the United States, WPV against healthcare workers in public and private sectors is four times higher than in any other industry. As the largest workforce in U.S. healthcare, nurses are prone to experience WPV than other healthcare workers. The American Nurses Association (ANA, 2019) estimates that nearly 62% of nurses have encountered physical or verbal WPV. Patients cause nearly 80% of WPV-related injuries in nursing care, especially during patient-nurse interactions (ANA, 2019). Emergency departments carry multiple patient-on-nurse WPV. This trend coincides with increased emergency department visits, including patients with acute psychiatric and substance abuse disorders.
Although common, nurses often minimize the seriousness of patient-on-nurse violence, reducing effective reporting. WPV constitutes a broad spectrum of violence, ranging from unpleasant language to homicide. Locke et al. (2018) define WPV as aggressive behaviors such as physical assault, threats, and verbal abuse towards a person on duty. This includes bullying, harassment, aggressive sarcasm, yelling, punching, throwing objects, or slapping. The most common form of physical aggression against nurses includes beating, shoving, hitting, and kicking (Locke et al., 2018). While most occurrences are non-fatal, patient violence against nurses can cause severe injuries and adverse effects on the nurses and the healthcare system.
According to d’Ettorre et al. (2018), patient violence contributes to harmful psychological effects, such as self-blame, anger, post-traumatic stress disorders, fear, depression, anxiety, and shame, reducing job satisfaction and staff retention. Nurses who witness WPV against a colleague or a health worker may opt to leave the profession, hampering efforts to mitigate persistent nursing shortages. According to Locke et al. (2018), WPV creates moral distress, poor morale, and occupational burnout, hampering effective healthcare delivery. Studies suggest that patient violence affects organizational performance and patient care outcomes due to medication errors, suboptimal productivity, and absenteeism (Locke et al., 2018; Liu et al., 2019; Simpson, 2016). Given the importance of therapeutic relationships in nursing, patient violence hinders effective communication and care delivery.
The Institute of Medicine (2010) asserts that nurses are equipped with unique skills and philosophical underpinnings to lead transformative changes in the current healthcare systems. According to Liu et al. (2019), the efficiency and quality of care delivery are subject to the value and size of the healthcare workforce. Thus, curbing WPV against nurses is fundamental to promoting staff retention and welfare (d’Ettorre et al., 2018). Studying this problem can inform best practices and proactive measures to enhance staff safety and patient care. The ANA (2015) position statement advocates for a zero-tolerance policy against "incivility, bullying, and workplace violence,” calling upon employees and employers to collaborate in developing a safe occupational culture through preventive procedures and interventions (ANA, 2015, p.2). Therefore, tackling the patient violence problem is an imperative goal in nursing leadership. The solution corresponds with the ongoing efforts to transform healthcare systems and optimize organizational effectiveness.
However, a poor reporting mechanism appears to propagate incivility and unsafe workplace culture. Thus, evaluating this problem in a work environment is vital to assess potential areas of improvement and policy changes. The goal is to identify knowledge and policy gaps about WPV among staff members. It seeks to establish the underlying risk factors influencing patient violence at work.
Literature Review
Patient violence against nurses and healthcare workers is linked to multiple risks in clinical settings. Without effective practices and protective safeguards, nurses are vulnerable to external visitors' violence at their place of work. Administrative reports reveal a positive correlation between patient violence and suboptimal patient satisfaction in nursing care (Stevenson et al., 2015). Nurses are also subject to burnout, occupational stress, and direct and indirect staff turnover. As a significant quality issue in patient care, patient violence connotes communication breakdown in therapeutic relationships. The nursing care process leverages therapeutic communication to provide compassionate care and address specific needs (Simpson, 2016). Thus, interpersonal awareness can help nurses recognize and manage triggers before they escalate to aggressiveness.
Verbal and non-verbal cues such as agitation, escalation, anxiety are foundational indicates of imminent aggressiveness (Locke et al., 2018). However, some threats transcend nursing practice and require a comprehensive response. As a result, the ANA (2019) advocates for a zero-tolerance policy, denouncing all forms of violence against nurses. Insufficient measures to curb violence against healthcare workers propagate an insecure organizational culture. It creates chaos and disturbances, negating nurses' ability to provide compassionate care. To this end, quality improvement initiatives have shown significant implications on curbing WPV orchestrated by the patients (Arnetz et al., 2017; Lantta et al., 2016). Staff training and situational awareness contribute to situational awareness and de-escalation strategies (Liu et al., 2019). For instance, mental health and trauma care units exhibit higher rates of patient violence.
Recognizing environmental factors helps nurse leaders to advocate for better organizational safety. Still, knowing potential triggers and aggravating factors can help staff members initiate de-escalation triage. Common triggers include unmet expectations, a history of abusive behavior, upsetting diagnosis or prognosis, and apparent loss of control (Lenaghan et al., 2018). Aggravating factors include withdrawal symptoms due to substance use and alcohol, trauma, verbal or physical history, and psychiatric diagnoses. Nurses with such understanding can mount defensive and proactive strategies for self-protection against patient violence. The ANA (2019) obliges nurses to report threatening workplace factors for practical quality improvements and evidence-based practices. A robust incidence-reporting system promotes situational awareness, providing a justifiable groundwork for advocating better and safer working conditions (Lantta et al., 2016). It can capture all patient violence incidents and help predict organizational, individual, or knowledge areas that require QI initiatives.
WPV training and QI programs' core components focus on promoting awareness of potential triggers, risk factors, and de-escalation strategies, mainly through less restrictive measures to calm aggressive demeanor (d’Ettorre et al., 2018). Staff members also learn how to respond to and manage verbal and non-verbal threats. Some programs incorporate hands-on simulation to enhance preventive interventions. Successful interventions require support from organizational leadership, administrative resources, patient-centered care plans, data collection to identify policy gaps, and debriefing techniques (Arnetz et al., 2017; d’Ettorre et al., 2018; Latta et al., 2016).
Although the risk of patient violence is subject to variances based on clinical settings, successful prevention programs comprise foundational principles such as mutuality, peer support, safety, collaboration, trustworthiness, and transparency (Arnetz et al., 2017). Cultural congruency and gender awareness are crucial elements that reduce aggressive triggers stemming from staff members. Standard techniques for mitigating patient violence integrate environmental, administrative, and behavioral strategies. In acute nursing settings, locking units during off shifts have can provoke hostility among patients (Stevenson et al., 2015). However, staff-training workshops that include unit-specific and house-wide have proven effective to patient hostility against nurses. Annual behavioral management training can also enhance effective responses to patient violence prevention.
Interprofessional collaborations, such as working with psychiatry, security personnel, and emergency response teams support timely interventions (Simpson, 2016). Mandatory teambuilding and self-defense lessons have profound impacts on optimal environmental and behavioral interventions. The installation of panic alarms and security cameras in nursing units or strategic locations supports prompt response and peer support (Lenaghan et al., 2018). Staff members also receive training on remaining calm when dealing with aggressive patients and seeking help before full-blown harassment (Locke et al., 2018). A strong workplace culture discourages overt and covert violent practices among all stakeholders. High-risk emergency department settings require optimal lighting, effective staffing policies, and regular security assessment reports (Liu et al., 2019). Besides, convening regular staff meetings creates a supportive environment to brainstorm occupational health and safety improvement strategies.
Briefly, patient violence against nurses has profound impacts on patient care and the nursing profession. However, establishing an incident report system and regular staff training programs can help mitigate patient hostility and other WPV incidents. Interprofessional workplace violence initiatives may contribute to comprehensive reforms and safer working conditions. This requires support and commitment from organizational leadership structures and staff collaboration for optimal outcomes.
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- Arbeit zitieren
- Anonym,, 2022, Patient Violence against Nurses. Prevention and Solutions, München, GRIN Verlag, https://www.grin.com/document/1359141
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