1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 13 Violence in Nursing: The Expectations and the Reality

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Violence in Nursing Misinterpretation of term, language to describe behavior Lack of agreed-upon definition –Different terms used to describe violent behavior Horizontal violence, bullying, lateral violence Mobbing (Europe) Bullying (UK) Workplace violence as preferred term globally Theory: framework of oppression theory

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Research & Violence in Nursing Research spanning geographical locations, specialty areas, students and faculty Violent behavior not unique to any specific country, location, or level Violence as a common theme but definition or language used dependent on researchers’ or practitioners’ perspective

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Violence in nursing has been defined specifically and concretely.

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. There is a lack of a uniform definition of violence in nursing as well as a misunderstanding of what the term “violence” means.

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Typology of Violence in Nursing Nurse-to-nurse violence (horizontal violence) Patient-to-nurse violence Organization-to-nurse violence (vertical violence) External perpetrators (strangers, visitors) Third-party violence (colleagues/family members) Impact of mass trauma or natural disasters on nurses (earthquakes, tornadoes, tsunamis) Nurse-to-patient violence

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Violence & Nurses Nonphysical violence –Verbal abuse—most common (see Box 13.2) Yelling, swearing Threats Physical violence –Slapping/hitting/punching/pinching (see Box 13.3) –Lashing out –Spitting

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Victims Violence against female nurses > male nurses More research needed to evaluate if forces affecting female nurses are the same for male nurses

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Addressing Violence in Nursing Complex problems requiring broad and sustained approach Perception of violence as part of the job –Nurses reluctant to report Ethical and legal principles that apply –Do no harm –Duty to care Consideration of consequences of actions so no breach of legal obligation to colleagues and patients

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Government Responses Many countries with legislation focusing on workplace violence; behavior considered an occupational health and safety hazard Statutory responsibility to meet standards, provide training and education, require reports

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins U.S. Response OSHA-workplace free from recognized hazards –If high risk of violence recognized as serious hazard, employer required to take steps to minimize the risks –Failure to do so, OSHA violation States: elevation of category for the offense and subsequent penalty

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? An underlying ethical and legal principle associated with violence in the workplace is duty to care.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. The ethical and legal principles that apply to violence in the workplace are do no harm and duty to care.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Canada Provincial occupational health and safety legislation Ontario definition of workplace violence –Exercise or attempt to exercise physical force against a worker, in a workplace which causes or could cause physical injury to the worker –Statement or behavior to be reasonably interpreted as a threat to exercise physical force against the worker in a workplace that could cause physical injury to the worker

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Australia Use of terms: “inappropriate behavior” or “bullying” Bullying –Behavior directed to employee or group of employees –Repeated, systematic –Expected to victimize, humiliate, undermine, or threaten the employee or employee group –Risk to health and safety Laws for criminalizing bullying Nurses legislation

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins International Human Rights Basic human right to work in a safe and healthy workplace Workplace violence = human rights issue Universal Declaration of Human Rights (UDHR) –International Covenant on Economic, Social and Cultural Rights (ICESCR) –International Covenant on Civil and Political Rights (ICCPR)

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Organizational Approach Legal and moral duty of care to employees –OSHA legislation –Policies and procedures –Education and training –Organizational culture

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins International Recognition ILO, ICN, WHO, PSI paper: Framework Guidelines for Addressing Workplace Violence in the Health Sector: Joint Program on Workplace Violence in the Health Sector The Inaugural International Workplace Violence in Health Care Conference Nursing organizations sponsoring conferences for promoting research

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? An important measure for stopping workplace violence by an organization is for that organization to adopt a culture that does not condone the behavior.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. An organization may address violence in nursing through policies and procedures, education, and training as well as having an organizational culture that does not condone the behavior.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation