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How safe is the health care work environment? its the question that all the nurses always ask themselves. This question rises because there are many nurses, who imagine that troubles can interrupt their safety and well-being in their work place at any time. Health care area has many hazards and nurses are repeatedly exposed to these hazards such as needle pricks and other injuries as a result of incorrect body mechanism. On the other hand, nurses are expected to work for long shifts and provide care for many people with different ranges of needs which make the nurses considered as a high-risk occupational group for exposure to workplace violence and aggression.
Work is always hard for nurses and they are responsible for identifying, knowing and understanding the different type of expected hazards that could happen in their work place and proper intervention to avoid these kinds of risk is vital. Today, violence with its different type considers the major factor that could impact nurses' safety in their work setting.
Therefore, this paper will explore the work setting violence against nurses by describing the violence types, risk factors, its occurrence and how to avoid it or how to manage it if happens.
Violence in the health care
Violence in work setting has been defined in literature in different ways according to its types, situations and results or complications. In general, and widely spread definition illustrates workplace violence as the incidents in which staff are abused, threatened or assaulted in various circumstances. (Isaksson, et al, 2007).
Work-related violence considers the major hazard that could threaten the work safety, and wellbeing particularly, in the health sector. Accordingly, it can affect the health sector productivity. Not only by it's impact on the absenteeism, and stress of employees but also on their work performance quality and efficiency (Sharipova, 2008). Work-related violence types, include physical assault, verbal threats, bullying, and sexual harassment. Usually violence could happen in the healthcare setting by many sources, but in the healthcare area most of the violence cases that were reported are mainly due to two sources, either by the worker colleague themselves or by the patients or the customers of the health care. However, these attacks could also occur by other sources such as, family, members, and co-workers. (Hutchinson, 2010).
Current studies (Howerton, 2010) show that, violence incidents against nurses in the work places have significant percentage which can't be ignored. A research done in USA by the Health Services Research Department (McKinnon,2007) had shown that scratching/pinching and hitting were the highest percentage of the frequent violence types which reached approximately to 63 percent and being held is consider the second as it is nearly 32 percent of the frequent types of violence in healthcare places. While, kicked was only 27 percent of the violence incidents type in the healthcare workplace.( Sharipova. 2007).
On the other hand, other studies (Pierre, 2008), (Macintosh, 2005)) presented the violence incident according to the different occasions such as, a study finding which reported that, the most common health workplace areas, that caregiver could expose more to the violence risk is in the emergency care settings, psychiatric care settings (McKinnon, 2007), and elderly care settings (Sharipova, 2007) (Isaksson, et al, 2007) (Kling, et al, 2009). Other study finding presented that the women are more at risk than the men (Valhmu, 2010).
People who are affected are those who work alone, late at night, individuals who are going into inadequately light parking areas as well as, iindividuals who are ignoring the potentiality of attacks. (Valhmu, 2010; Kling, et al, 2009)
Common Risk Factors for Health Care Agency Violence:
Those risk factors could be as a result of weakness or lack in any of these sources, such as, the organization strategy or the workplace situation or the worker themselves. As a weakness in the organization or agency the risk factors for the violence will include:
A weak or unavailability of a clear guidelines or policy against violence attacks within the organization to support the victim in workplace will make the worker in that organization unsafe from violence attacks (Kling, et al, 2009).
Shortage in the employee, supervisors, mangers and securities numbers, could increase the workload in the employees, and it might increase the waiting time of the customer, which might lead to increase the chance or the risk for occurrence of any type of violence in that organization. lack in the training programs (in other words antiviolence policies and prevention strategies) that organization should arrange and provide for their employees to orient them about the violence type which they could face it in their workplace, also the way which they could prevent it, and the way that they should manage it if it happens, how to report it, can make the workers in that organization in high risk of any type of violence ( Ryan, 2006).
Delay or inability of the notification or reporting violence attack will increase the chance of repeating the violence attacks. The deficiency or non availability of adequate threats assessment, by the managers, and the supervisors in any organization, will lead to inability to control or avoid other aggressive or violence attacks. The chance or the risk of having repeating the same violence attack or may be more severity attacks, can be occur when the organization has failed to take an immediate intervention against those people, who have threatened or committed acts of violence (Katula, 2006).
Other risk factor:
People in the workplace such as patients, visitors or even the workers, also, might consider as a risk factor of bulling or different types of violence. This type of risk could be clear in case of any of these situations happen, but most of the time aggravated assaults are conducted by surprise and with intent to rob ( Dilek, 2008). For example, when the language or behaviour of another employee, a patient, or a visitor is perceived as threatening. Other examples include threats or increase of gang members, drug or alcohol abusers, trauma patients, or distraught family members. In addition to these expressions of intent to cause harm, including verbal threats, threatening body language, and written threats and physical assaults (Abuairub, et al, 2007). (Farrell, 2006). Cases of attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives Muggings.( Clements.2005).
The Literature review has shown a finding of a study has been conducted in London by the health Services Research Department which had presented some common themes had been highlighted from that studies regarding psychiatric ward workplace violence (McKinnon, 2007). These themes were as a following:
The chance of the violence risk will be more, if the worker were Unqualified, or junior staff, than if the worker were senior trained staff.
Although there are a number of factors that make the violence or aggressive attack from the inpatient side are expected, but it was also clear that the higher percentage of violence attacks was coming from the inpatients who are complaining of dual diagnosis issues (mental illness and drug use).
Workplace environmental factors can increase levels of violence such as ward layout, lack of programmes, boredom, and staff attitude towards patient.
In addition to these other studies reported that the risk of violence is increasing in small cities than in large communities, and mostly occur in small hospitals (Roche, et al, 2009).
There are occurrences of aggressiveness or bulling among employees at the same level within the same organization. These concepts have been used to identify this type of bullying or violence. This kind of bullying could be as a result of their low self-esteem or direct abusive behaviour towards or abuse to position, power ot each other (Jacobson, 2007).
Negative effect of the violence on the victim:
When victim is exposed to any type of violence, the victim will feel very weak and helpless in facing powerful people. This leads to make the mobbing occur (Hutchinson, et al, 2005). According to a study done by leymann harassment that the victim could expose is identified in five different categories of terrorising behaviours (psychological violence) to make the victim under more pressure. These are: first was the effect on the victim possibilities to communication adequately. Second was the effect on the victim ability to maintain social safety. Third effect was on the victims' possibilities to maintain their personal reputation, and the fourth effect was on the victims' occupational situation. Finally and fifth effect was on the victims' physical health.
repeated violence attacks can lead to sever bad effect in the victim psychologically, physiologically and socially such as, decrease self-respect and experience anxiety, depression and rage in addition some victim even attempt suicide. it could also have a negative effect on the workplace itself. For example when the victim is exposed continuously to systemic violence attacks in the workplace the victim will start to feel unsatisfied in the workplace, unsafe, without support, reduced emotional engagement in work then burnout. Moreover, the victim might plan to resign either by his own decision or by external pressure ( Duddle. 2008) . This in turn, will affect the patient care and the organization productivity too.
As Workplace violence against the nurses has been shown to be a significant source of stress as it is associated with high levels of burnout, and increased staff turnover. For this reason, it is very important to develop a plane to manage or either prevents this kind of stress.
Workplace violence prevention:
The development and implementation of workplace violence prevention programs must include:
Workplace analysis, management commitment, employee involvement, work site analysis, hazard prevention and control plan, training and education, and reporting system.
Each workplace is different from other one and it is best establishing and implementing workplace violence prevention plan. The first step in this should be to evaluate work place safety and to analyze all possible aggressive and violence sources by committee (a threat assessment team). This committee responsibility is to control and prevent hazards by modifying the work environment, and changing work process if needed, and recommending a special policy that provides work-related risk management as ''zero-tolerance policy''. It's a guideline that could be used for preventing workplace violence such as verbal and nonverbal action related action. ''zero-tolerance policy'' will not work efficiently, unless it is applied to all the groups and with no expectations. Also, workers, managers, supervisors, visitors and patients should be informed about these guidelines.( Buerhaus,2008)
The organization should appoint a competent staff to be as a member of threat assessment team. Nursing staff and occupational nurses should be involved as members in such group as they have essential information and knowledge about standard workplace.
Work site analysis and hazard prevention should begin from the top level to the bottom level, on other hand safety and health of employees in the workplace should be the ultimate responsibility of the employer. For that, the organizations need to thoroughly screen candidates and avoid any candidates who had history of violence involvemnet or have any character of trial. It is also important to make regular workplace inspections to investigate hazards, accidents, and complains etc.
The final step in bulling and violence prevention plan is to provide the entire workers by training and education programs about violence risk factors, situation, and how to manage it or how to avoid it. Furthermore, to encourage them to report the violence attacks and to inform them about the correct notification process, and ensure them that there will be enough support from the organization.
In conclusion, Nurses today are spending most of their working hours in the Workplaces, but sometime the workplace might make them under high risk of different type of violence. accordingly, it could affect their productivity and patient care. For that, health and safety and its regulations require district nurses to cooperate with their employers to manage health and safety while at work, by identifying hazards through risk assessments and in reporting incidents that could threaten their employers and customers safety and health.