Discuss about the Violence from Patients towards Nurses.
Violence from patients towards nurses
Within the health care system, nurses play an important role who are vulnerable to abuse and violence from patients. Australian Institute of Criminology has also identified related issues in nursing profession and growing risks in this occupation. Disturbed mental state and exposure to physical distress has been the core reason behind increasing client violation in hospitals. Recently many episodes relating violence against nurses have been identified which highlights inadequacy in the field of protection for nurses. One taken place in The Royal Melbourne Hospital in Victoria and Wyong Hospital situated in central coast of NSW, patients have been seen attacking nurses with knives (Pich, 2017). With both the incidents it becomes clear that nurses in nursing profession have become exposed to physical and verbal violence and have even started accepting it as a part of their job. Since violence from patients towards nurses have become a significant issue that requires to be looked upon, this paper will analyse the situation in depth while concluding with possible solutions for it. According to World Health Organisation (WHO), violence in healthcare profession has been due to the reason where both victim and the saviour behave in an unintentional manner in which both physical force and threatening the other person or community along with oneself takes place. The result of such actions may result in injury, psychological damage and deprivation (Krug, 2002).
Violence in nursing profession has a huge impact on health care workplace which threatens work efficiency and quality. With due respect to individual rights and integrity, assaults on nurses have left detrimental notion on the minds of nurses and ones who wants to become a nurse. Current literature on nursing profession suggests ensuring the safety and respect for the profession or else degradation and scarcity can be expected in the future and hence this issue can be directly related to a professional issue (Sharma, 2016).
Evidences in health care profession have reported a limited number of cases where professional nurses have been compensated for misbehaviour faced by them (Gates, 2011). Western Australia has reported that personal threats and referral to psychiatrists have demoralised nursing professionals to a great extent. Nurses as an individual does not want to be disloyal to their patients regardless, lack of reporting has made the issue more reorganised. This attitude of nurses reveals their professionalism and their dedication towards their profession. But recent attacks and bullying of nurses have began a new revolution in this field wherein the culprits are been accused by state criminal departments and The International Council of Nurses described this issue as a “World-wide Epidemic” (Roche, 2010).
Abusing and physical attacks have shown post traumatic depressions among nurses which have made them consuming alcohol and even drugs along with suffering chronic pain. Minor scratches and bruises to serious injuries like fractures, stabbing and even death have been reported lately in nursing journals. A nurse was punched in face and was stabbed by a butter knife in her breast and back area. This incident took place in 2011 in NSW region where a mentally disturbed patient stabbed a nurse to death. Following it was another incident in Southern Australia where a nurse was kidnapped, raped and killed (The Conversation, 2017). These two incidents shows the exposure of nursing profession to patient related violence and their adverse affects on patient- nurse relation. Nurses can treat their patients less empathically and give up their work quality if similar incidents of violence are experienced by more of them.
According to a survey made by International Council of Nurses (ICN), studies conducted in different countries healthcare departments reveals the amount of physical violence in workplaces and reasons behind quitting nursing job. The study collected various samples and prepared a questionnaire where hospitals and health care professional were asked to share their individual experience in their profession. As shown in the figure below, indicates that physically attacked nurses were 2.7 times more who desired to quit job as nursing than nurses who have not yet faced violence attack issue.
Source: (Hancock, 2017)
Database research made from CINAHL and MEDLINE reviews on the impact of patient violence against nurses working in healthcare workplaces by making interactions with nurses. According to the survey, workplace violence and bullying victims made patients more comfortable as they can share their experience with friends and relatives. Local hospitals and staff had to make anonymous calls to officials for reporting abuse and seeking help from them (Koh, 2015). Similar research made by researchers reveals that the rate of increase in violence is alarming with a rise of 110persent where incidents had been reported directly by the nurses. Since no federal rules have been imposed in health care work areas, protection of nurses is still under question. An incident in California where a patient kicks a pregnant nurse in her pelvis has made the entire profession under public eye (Campbell, 2016).
Although nurses are seen more vulnerable to violence in hospitals, but adverse affects on patient safety is also an issue that requires to be given stress upon. Impairment and demand to leave the place makes patients more irritated and result in getting violent attitude. One of the incidents mentioned is where the patient demanded for a leave and had to wait for longer period became frustrated and violent. Similar case happens in workplaces where they are reverse attacked by nurses and thereby risking patient safety. Since patients admitted must be having health or mental problems, they at some cases prove to be more venerable in violent attacks. Themes related to patient care in general indicate violence occurred with patient during treatments which involved physical as well as mental discomforts. Patient demanding for moiré help and assistance are the most who suffers from violence and under force made counter attacks to nurses. Many incidents states that infuriated nurses have given serious injuries to patient by giving false medication and inserting needles. Many times patient out of pain and fear becomes aggressive and out of control thereby harming themselves and others. In this kind of situation, nurses requires to be more alert and take precautionary measures as patient in those conditions are mentally misbalanced and attacking them back can cause permanent disability (Arnetz, 2016).
In last few decades the quality of work and humanity has evolved the thinking adversely. Nursing professionals are responsible for patient safety in terms of medication and care and if such attention is not recognised, patient tends to lose faith in the system and on the profession. The lack of communication due heavy load of work can make patient lose temper and become violent. Similarly work pressure makes nurses more aggressive who even lead them avoiding responsibility in their work.
Source: (Desanto, 2013)
Patient safety and violence have been a key issue as shown in the figure above. Nurses who show recklessness have given bad effects in victim’s minds as compared to ones who get good treatment from nurses at the time of treatment. Such irresponsible attitude indirectly refers to the violence in the work culture of nurses in which patient security is hampered. In accidental wards where patients are admitted due to injuries and fractures are the ones more prone to nurse’s violence. Since their physical conditions do not allow them to revert back, nurses take the advantage and can become violent in severe conditions. Government hospitals and health camps are mostly seen with such conditions where patients have to suffer violence since work load there are always higher and nurses being limited in numbers (Mitchell, n.d.).
However, violence from patient towards nurses has become a key issue in today’s health care units and thus many steps have been incorporated by hospitals and nurses training organisations. In Australia, Code of Conduct for maintaining self care, Section 7.1 states that Code of conduct for Nurses and Code of Conduct for Midwives must be followed by hospitals and training organisations to reduce stress and fatigue in their health. Organisational strategies to ensure observance of professional codes while focussing on individual health is improvised in today’s hospitals. Many training programmes have been introduced so that nurses are provided with mental peace and ability to deal with the situation tactfully (NSW Nurses and Midwives’ Association, 2018).
Many strategies have been applied to make workplace secure for nurses, still there are few strategies that can provide more advancement in the system. Two of the strategies recommended after reviewing the issues are:
Early investigation of incident- According to researchers if any incident in investigated in early stages, the chances of getting it sorted becomes easy. Violence can began from quiet state and end with aggression and discomfort along with attacks. If the situation is intervened in early stage, escalations can be avoided by breaking the cycle of interaction. For example, if a patient and a nurse fall in a conversation leading to violence, other team members witnessing or with the help of hidden cameras can evaluate the discussion. Breaking the conversation and distraction might prevent the incident getting violent. The appointed nurse can be shifted to other department or work area so that facing the accusing patient is avoided(Mcknight, 2014).
Training programmes for avoiding aggressiveness in nature: Literature in health workplace reveals that lot of patient are prone to nurse’s aggressive attitude due to work pressure which in turn becomes patient’s motive to attack violently. Since, patient cannot be trained for behaving in work premises; it is the duty of organisations to train their nurses for behaving in calm and composed manner especially with patient suffering mental problems. Education on preserving and developing therapeutic care while interacting with patient will not only decrease violence but also make work environment more peaceful and healthy(Mitchell, n.d.).
The impact of increasing violence has given lead to significant traumatic issue on nurses that requires to be focussed upon. Therefore, after reviewing the aforesaid topic, it can be said that violence in nursing profession is directly related to a professional issue that needs to be monitored and regulated by proficient teams and nations.
Arnetz, J.E., 2016. Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006065/ [Accessed 11 April 2018].
Campbell, A.F., 2016. Why Violence Against Nurses Has Spiked in the Last Decade. [Online] Available at: https://www.theatlantic.com/business/archive/2016/12/violence-against-nurses/509309/ [Accessed 11 April 2018].
Desanto, J.D.R.W.a.L.B., 2013. Measurement and Monitoring of Health Care Worker Aggression Exposure. [Online] Available at: https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No1-Jan-2013/Measurement-and-Monitoring-Worker-Aggression-Exposure.html [Accessed 11 April 2018].
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Koh, W.M.S., 2015. Management of work place bullying in hospital: A review of the use of cognitive rehearsal as an alternative management strategy. [Online] Available at: https://www.sciencedirect.com/science/article/pii/S2352013215300247 [Accessed 11 April 2018].
Krug, L.L.D.J.A.M.A.B.Z.a.R.L., 2002. World report on violence and health. [Online] Available at: https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf;jsessionid=AB9BB81437949EFC11C8D515EFC9E257?sequence=1 [Accessed 11 April 2018].
Mcknight, S., 2014. The Nature of Violence: Origins and Prevention of Healthcare Violence. [Online] Available at: https://www.omicsonline.org/open-access/nature-of-violence-origins-and-prevention-of-healthcare-violence-2167-1168-3-183.php?aid=28036 [Accessed 11 April 2018].
Mitchell, P.H., n.d. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. [Online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK2681/ [Accessed 11 April 2018].
NSW Nurses and Midwives’ Association, 2018. MAKING TIME FOR ME: the emerging role of mindfulness practice in self-care for nurses and midwives. [Online] Available at: https://www.nswnma.asn.au/wp-content/uploads/2018/04/Making-time-for-me-FINAL.pdf [Accessed 11 April 2018].
Pich, J., 2017. Nurses are at the front line of violence in hospitals, to the point where this has become an expected and even accepted part of their job. [Online] Available at: https://www.sbs.com.au/topics/life/health/article/2017/05/17/violence-against-nurses-rise-protections-remain-weak [Accessed 11 April 2018].
Roche, M.A..D.D..D.C..&.C.-P.C.J., 2010. Violence toward nurses, the work environment, and patient outcomes. [Online] Available at: https://opus.lib.uts.edu.au/bitstream/10453/13764/1/2008005296.pdf [Accessed 11 April 2018].
Sharma, R.K.S.a.V., 2016. Journal of Nursing & Care. [Online] Available at: https://www.omicsonline.org/open-access/work-place-violence-in-nursing-2167-1168-1000335.php?aid=72181 [Accessed 11 April 2018].
The Conversation, 2017. Violence against nurses is on the rise, but protections remain weak. [Online] Available at: https://theconversation.com/violence-against-nurses-is-on-the-rise-but-protections-remain-weak-76019 [Accessed 11 April 2018].