Building Professional Capacity For Prosperity: Reflection On Workplace Violence In Nursing Practice

Reflection

Discuss about the Building Professional Capacity for Prosperity and modification.

Self-reflection is a part and parcel of professional practice that helps in improvement, prosperity, modification, adjustment and experience development for once own profession (Yoder-Wise, 2014). This work is one such self-reflection study using 5Rs Reflection Framework (Reporting, Responding, Relating, Reasoning and Reconstructing) to understand the issue of workplace violence in personal professional nursing practice.

This self-reflection study is workable to understand the key aspects of workplace violence issue in nursing as well as develop professional strategies to address this issue in future nursing practice.

Workplace violence by the patient is a human psychological disturbance that can lead to dangerous consequences for nursing carer’s dealing with such patient (Etienne, 2014). As a GRN this reporting describes a personal encounter with workplace violence. The emergency department was in worst position due to full occupancy. While practicing it was observed that all the healthcare professionals, as well as patients, were in stressed condition. A patient (Mr. X) arrived complaining about high blood pressure and severe chest pain. This patient was also complaining about shortness of breath indicating emergency requirement. As a part of professional practice, it was required to find a room to attend this patient as his condition indicated a serious problem. The emergency department was full of the rush; it was difficult to find immediate vacant room. However, one room was managed, the patient was put on a stretcher and taken inside the room.

The medical process started with putting oxygen monitor, blood pressure cuff and cardiac leads. The patient was continuously demanding to call his wife but as per professional practice norms, it was requested that patient should keep calm and give his blood pressure further he can call his wife. As the process of taking blood pressure started, patient lost control over his mind and just punched on the face. The punch was so violent that the body moved against the supplies holding cart.

However, as a part of professional practice and emergency requirement, it was required to still attend the patient. Ignoring the previous act, the blood pressure was taken and patient’s wife was informed about his condition. After this further medical assessments were performed where patient lost his temper number of times until doctor arrived at the room. The patient lost his level of control and tried to hit many times with vigorous intention during this assessment. The scars on face and body were visible with naked eyes. Complain was filled for this patient to take appropriate action against him.

Reporting

Workplace violence is an uncertain psychological disturbance developed by feelings like anger, fear, anxiety, depression etc. In general, this incidence can happen with anyone. Workplace violence against healthcare workers holds almost quarter of total workplace violence events (Taylor & Rew, 2011). Littlejohn (2012) studied that 40% of nursing professionals are victim of workplace violence in Australia and 79% experience aggression by patients. In 90% of workplace violence cases, attackers on nurses are the patients, their families or friends. According to Speroni et al. (2014) studies workplace violence is an intentional or unintentional physical, mental or psychological damaged caused in the forms like harassment, disruptive behaviour, threatening, bullying, intimidation and physical violence. This can involve any person at work site that can be client, customer, worker, employee or visitor.

In the present case, ED patient irrespective of any personal issue performed an act of physical violence with the involved nurse. As per personal opinion and observation, this act can be considered as a rude and disruptive behavior by the patient harming the identity and dignity of care nurse. Such incidences make the nursing profession a challenging and risky profession (Esmaeilpour, Salsali & Ahmadi, 2011). In support of this statement, Becher & Visovsky (2012) opines that nurses are ever in front-line violence in hospitals because they are the first person to encounter patient.

As per personal observation, in the present case-patient was emotionally disturbed with sudden health issues that indicate a heart attack or disease. Therefore, he needed a family support before getting involved in any kind of treatment or diagnosis. This patient was surely not aware of the initial test that is very essential to be performed in this case. This can be considered as the only reason for this disruptive behaviour of the patient. However, still, the act of physical violence is an unacceptable phenomenon for any professional especially nurses working as a care provider for people.

A feeling of disrespect and affront arrived in personal perception for this act of physical misbehaviour by the patient. Magnavita & Heponiemi (2011) indicated that over-demanding workloads and lack of workplace autonomy are the reasons that lead to nurses exposure to workplace violence. This similar phenomenon is observed in this case because in the emergency department lack of care providers created immense workload leading to stressful condition. Further, working as a graduate nursing student there was lack of control over situation due to lacking nurses autonomy. Lastly, workplace violence can never be understood because it is an act of human psychological disturbance and it can happen to anyone but due to unknown reason, this issue is very prominent with healthcare providers especially nurses. Instead of considering nurses with respect and dignity for providing care and support, patient treat them as slaves with their inhuman behaviour like workplace violence (Magnavita, 2014).

Responding

In the present case, as a professional being a graduate registered nurse even after the incidence of workplace violence this patient was attended to ensure his safety and health condition. This indicates that at some place or the other professionals are now adapted to consider workplace violence as a part of their care profession because in nursing care professional deal with people (not things). These people are either physically or mentally disturbed; therefore workplace violence is an accepted phenomenon to some extent. Edward et al. (2014) studied about ‘a theory of adaptation’, as per this theory, nurses have developed an understanding towards workplace violence in their profession. Nurses use cognitive processes for finding meaning, gaining mastery and enhancing the self for work-place violence.

However, in contrast, Park, Cho & Hong (2015) indicate workplace violence as one of the most complicated and hazardous issues in the healthcare system. Healthcare culture is to heal, recover and strengthen the inner and outer spirit of the human body. Any kind of dangerous activity harming the physical and mental health of the person can never be considered as a “part of the job”. This theory completely rejects the phenomenon of adaptation. Workplace violence is an emerging hazard for the healthcare system that requires clear and appropriate interventions to stop workplace violence.

As per Australian Government figures, “code blacks” are the incidences where hospital staff safety in under risk. In the year, 2015-16 there were 4,765 code blacks that have increased to 6,245 code blacks in 2016-17. The 90% of code black happen in the emergency department. Farrell & Shafiei (2012) indicated that work overload is a major reason that leads to abusive treatment of nurses by the patient and their family member. A per one research by Australian Catholic University 269 aged care provider nurses out of 300 reported about physical violence by the patient or their family member in workload shifts whereas less than 100 reported physical violence in normal working hours. As per this research finding, the arousal of tension due to workload leads dissatisfaction in the patient and their family that creates workplace violence. In the present situation, huge rush in the emergency department indicates a similar workload situation that created mismanagement and dissatisfaction among patient leading to workplace abuse conducted on GRN.

As per Kowalenko et al. (2012) studies, there are various factors that motivate and contribute to emotional and psychological vengeance like workplace violence. Some of them are poor management practice, unhealthy working environment, lack of awareness, insensitive hold over workplace diversity, perpetrators revenge and spontaneous reaction to harassment. Further, adding to this, lack of workplace training and support system is another reason contributing to issues like workplace violence. In the present situation also, as a graduate nurse, lacking workplace training and unavailability of proper support system can be considered as reasons or factors that made nurse unable to handle the physical violence incidence. As a graduate RN working as a trainee a very less knowledge to handle workplace violence was known. Further, it was the first experience as a trainee; therefore, the process to handle the situation was unknown. The only point in perception was to provide proper care to the emergency patient, as his condition was severe and sensitive.

Relating

Further, the workload was another factor that created a situation of miscommunication with the patient. Mitchell, Ahmed & Szabo (2014) indicated that shortage of nurses especially in the emergency situation is a major defect in the Australian healthcare system. As per statistics shortage is increasing at the rate of 0.5% every year in the country. This is another indirect factor that has created pressurized workload in the present case. Being a graduate nurse, lack of knowledge and experience added an advantage to this workplace violence. Hence, these are some of the factors that created workplace violence in this case. However, these are some of the most common causes of workplace violence in healthcare system (AbuAlRub & Al-Asmar, 2014).

By analyzing the above case it is clear that workplace violence remains a serious issue in healthcare management system and nurses or first line care providers are the major victims of this issue. In the present situation, factors like emergency rush, psychological disturbance in patient attitude, lack of nurses and lacking professional experience contributed to workplace violence matter. But, as a healthcare professional it can be assumed that such encounter with workplace violence shall remain common in future practice as well. Therefore, As a GRN, the first encounter with workplace violence can be considered as a lesson to restructure future plans and add certain requirements to personal professional nursing practice.  Some of the initial strategies that can be adopted to restructure nursing practice and deal with workplace violence involve attending workplace violence prevention program, learning from workplace violence prevention resources and self-defense classes (Gillespie et al. 2010).

There are work place violence prevention programs developed to ensure the safety of healthcare workers by the public as well as private safety departments of the country. Piquero et al. (2013) indicated that these WPV prevention programs are meant to let people understand consequences, nature of violence, risk factors, prevention strategies and post-event responses. By getting involved in these programs any professional can recognize warning signs of workplace violence prior to the event. They can also perform communications, teamwork to prevent such event and manage post-violence consequences. As a graduate registered nurse getting involved in WPV prevention program will help to gain experience in handling such unexpected situations in future. These WPV programs are out of the box courses that nursing professionals should take because they are mostly the victims of workplace violence.

Another futuristic goal to deal with workplace violence includes learning from workplace violence prevention resources that help to develop awareness and management of the vulnerable situation. Chen, Ku & Yang (2013) indicated that government of Australia and other countries have now established their Health Education and Training Centres that provide guidelines, rules, books and other resources that educate and provide training to professionals for dealing with issues like workplace violence. These resources work as the theoretical source to gain deep knowledge on psychology, practically and circumstances of workplace violence. Further, policies, procedures, regulations etc. help professional in understanding the action they need to take in the phase of being a victim or vulnerable to workplace violence.

Another futuristic goal after being victim to workplace violence as a GRN is to ensure self-defence by taking self-defence classes because violence can be dangerous and harmful to health depending on the seriousness of vulnerability (Campbell et al. 2011). Therefore, before getting involved as a regular professional registered nurse one need to ensure personal safety. Self-defence classes will prepare oneself to ensure personal security and protection even in a complicated situation. Every nurse or any other professional should at least learn one self-defence skill to confront workplace violence (Albashtawy, 2013). With these futuristic goals, a planned and secure nursing professional attitude can be developed that will surely help to tackle any kind of workplace violence situation in the nursing profession.

Conclusion

The above self-reflection study on workplace violence issue using 5Rs framework can be considered as a very useful work to deeply understand the personal professional nursing practice on one specific issue. A detailed explanation on the issue or situation of workplace violence indicates certain loopholes that require correction for future practice. Such self-reflection can work to further understand and enhance professional practice not only in terms of one single issue but other situations or issues that impact nursing profession.

References

Books

Yoder-Wise, P. S. (2014). Leading and Managing in Nursing-E-Book. Elsevier Health Sciences. 

Journals

AbuAlRub, R. F., & Al-Asmar, A. H. (2014). Psychological violence in the workplace among Jordanian hospital nurses. Journal of Transcultural Nursing, 25(1), 6-14.

Albashtawy, M. (2013). Workplace violence against nurses in emergency departments in Jordan. International nursing review, 60(4), 550-555.

Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. Medsurg nursing, 21(4), 210.

Campbell, J. C., Messing, J. T., Kub, J., Agnew, J., Fitzgerald, S., Fowler, B., … & Bolyard, R. (2011). Workplace violence: prevalence and risk factors in the safe at work study. Journal of Occupational and Environmental Medicine, 53(1), 82-89.

Chen, K. P., Ku, Y. C., & Yang, H. F. (2013). Violence in the nursing workplace–a descriptive correlational study in a public hospital. Journal of clinical nursing, 22(5-6), 798-805.

Edward, K. L., Ousey, K., Warelow, P., & Lui, S. (2014). Nursing and aggression in the workplace: a systematic review. British Journal of Nursing, 23(12), 653-659.

Esmaeilpour, M., Salsali, M., & Ahmadi, F. (2011). Workplace violence against Iranian nurses working in emergency departments. International nursing review, 58(1), 130-137.

Etienne, E. (2014). Exploring workplace bullying in nursing. Workplace health & safety, 62(1), 6-11.

Farrell, G. A., & Shafiei, T. (2012). Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study). International journal of nursing studies, 49(11), 1423-1431.

Gillespie, G. L., Gates, D. M., Miller, M., & Howard, P. K. (2010). Workplace violence in healthcare settings: risk factors and protective strategies. Rehabilitation Nursing, 35(5), 177-184.

Kowalenko, T., Cunningham, R., Sachs, C. J., Gore, R., Barata, I. A., Gates, D., … & McClain, A. (2012). Workplace violence in emergency medicine: current knowledge and future directions. The Journal of emergency medicine, 43(3), 523-531.

Littlejohn, P. (2012). The missing link: using emotional intelligence to reduce workplace stress and workplace violence in our nursing and other health care professions. Journal of Professional Nursing, 28(6), 360-368.

Magnavita, N. (2014). Workplace Violence and Occupational Stress in Healthcare Workers: A Chicken?and?Egg Situation—Results of a 6?Year Follow?up Study. Journal of nursing scholarship, 46(5), 366-376.

Magnavita, N., & Heponiemi, T. (2011). Workplace violence against nursing students and nurses: an Italian experience. Journal of Nursing Scholarship, 43(2), 203-210.

Mitchell, A., Ahmed, A., & Szabo, C. (2014). Workplace violence among nurses, why are we still discussing this? Literature review. Journal of Nursing Education and Practice, 4(4), 147.

Park, M., Cho, S. H., & Hong, H. J. (2015). Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment. Journal of nursing scholarship, 47(1), 87-95.

Piquero, N. L., Piquero, A. R., Craig, J. M., & Clipper, S. J. (2013). Assessing research on workplace violence, 2000–2012. Aggression and violent behavior, 18(3), 383-394.

Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of emergency nursing, 40(3), 218-228.

Taylor, J. L., & Rew, L. (2011). A systematic review of the literature: workplace violence in the emergency department. Journal of clinical nursing, 20(7?8), 1072-1085.