Examining Violence In The Nursing Workplace Criminology Essay

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Violence is one issue that arises and increases world widely. It is not specific for one type of work; it occurs in each workplace; including health care settings. It can occur to anyone. It can occur to doctors, nurses, and even patients. Violence in nursing workplace has been increasing significantly that extend to all nursing working in different ward. Nurses have attacked of violence from patients, their families, their relatives, their friends, and even the staff themselves toward one another. It ranges from verbal abuse, threaten, to physical abuse. Before this happened, nurses must be aware of alarming signs of violence and situation that may lead to violence by predicting it. This essay, will define violence, discuss types of violence, areas where violence most likely to occur, groups that commit or act violence, mention why violence occurs to nurses, factors led to workplace violence and signs of violence. Finally, it will talk about issues and controversies, consequences and tactics to prevent workplace violence.

Definition of violence in nursing workplace:

It is difficult to define violence in nursing workplace, because of lake of global definitions of violence, and the word violence itself is unclear and has more than one meaning, put obstacles and hindrance for the researcher to define violence (Madangeng & Wilson, 2000, p.37).Thus, violence can be defined according to the world health organization as following ''the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community that either result in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation'' (WHO, 2002, P.14). It defined in other way as "violent acts including both physical assaults and threats of assaults, directed towards workers and those in the workplace"(center for disease control and prevention, 1996, p.450).

Types of violence:

Olszewski, parks, & chikotas (2007) divide violence in four types including: type one occurs when a criminal enter health care setting to commit a crime. Type two occurs when patients practice violence in health care place. Type three, violence occurs among staff themselves or by former worker in workplace. Type four: it happens when a person not working in the setting acts violence toward a staff that has a relationship with her/him. Other type of violence, which occurs among nurses themselves, called horizontal violence (Baltimore, 2006; Ramos, 2006). Horizontal violence including bullying, verbal abuse, criticism, gossiping, physical abuse, not sharing information, scapegoat…etc. (Baltimore, 2006).These behavior present in what can call toxic workplaces (Rowell,2005).

Areas where violence is most likely to occur:

Violence thought to be more likely to occur in psychiatric ward (Arentz, & Petterson, 1996; Hansen, 1996; lanza, Kayne, Pattison, Hicks, & Islam, 1996), geriatric ward (Chambers, 1998; Hagen & Sayers, 2005) and emergency department (Jakson, et al., 2002; O'Connell, Young Brooks, Hutching, & lofthousing 2000). However, nowadays it is equally occurrence in other hospital wards (Whittington, Shuttle worth & Hill, 1996; Winstanley & Whittington, 2002).

Groups that commit violence:

"It is not only the psychiatric patients who may have no insight into their behavior who become violent and cause injury. Anyone who walks through or is brought through our doors in capable of becoming violent" (Karen Wiley, 2009, December, Do not let violence happen to you, your staff, p.16-17). According to Duncan, Hyndman, Estabrooks, & Hesketh, (2001) and Lechky & Rafuse, (1994) four groups within the community can act violence including patients, colleagues in the work, friends and families and practitioners.

Why violence happen to nurses?

Because nurses give cares for patients and they have direct relationships with them, they are at risk of having more violent than any other health care personnel are (Ventura-Madangeng & Wilson, 2009, p. 37). Nurses working in emergency department, psychiatric ward, and geriatric care center they are at higher risk for violence than any other nurses working in different ward.(Needham, Abderhalden , Halfens, Fisher & Dassen,2005).Anderson & parrish (2003) stated that young nurses have risk of experience workplace violence due to lack of experience.

Attributes and factors that lead to workplace violence.

There a lot of attributes, that lead to violence towards nursing includes, feeling of powerless due to less information provided to relatives and family when they see their (Roche & Catling, 2009). Loose of control, pain, anxiety, disorientation can contribute to violence occurrence (Ferns, 2007). Nursing procedures may start various and different feeling and therefore violence attack occurs (Roche & Catling, 2009). Patient or visitor under the effect of alcohol or drugs, psychiatric patient in emergency department, long time to seen in the emergency department room, and credence (Do not let violence happen to you 2009 December, ED Nursing, 16-17).Having contact with patient through Administration of medication (LeBlanc & Kellowy,2002). Gender plays an important factor in the incidence of violence. Men are more likely to be a victim of violence than women are (Bowers et al., 2007; Nachreiner , Hansen, Okano, Gerberich, Ryan, McGovern, Church, &Watt, 2007: Quanbeck, 2006).Younger nurses lack experience may predispose them to workplace violence and this is because older and senior nurses are in management position and they have less contact with patient. (Anderson & Parish, 2003; Catlette, 2005; Duncan, Hyndman, Estabrooks, & Hesketh, 2001, Gallannt-Roman, 2008b; kamchuchate, Chongsuvivatwong, Oncheunjit, Yip, & Santhong, 2008; Little, 1999; Tang, Chen, Zhang, &Wang, 2007).

Beware of signs of violence:

" Certain behavior can signal escalation toward violence including rapid, loud, or profane speech, increased confusion or disorientation, clenched fists, gritted teeth, reddened face, widened eyes, flaring nostrils, rapid breathing, agitation evidenced by pacing, fear, or inability to remain still, hallucinations, and sudden change in or extremes of affect" (Disatsio, 2002, p.453).

Issues and controversies:

Shortage of staff or less staff per shift results in working alone and working an additional shift, which leads to increase workplace violence. (Gallant-Roman, 2008a; Tang, Chen, Zhang, &Wang, 2007). A report by emergency nursing association "that 5% of hospital had no security, and 13% relied on local police or the sheriff to respond." (Do not let violence happen to you 2009, December ED Nursing, 16-17).

Consequences of workplace violence:

Workplace violence has a numbers of consequences not only in the nurses themselves, but also on patients and organization where they work. These consequences include physical, emotional, professional, and organizational consequences. Emergency department staff who experience violent attack, they will have fatigue and burn- out. (Gates, Ross, McQueen, 2005; Hampton, 2007, Lewis, Dickinson, & Contino; 2007; Luck, Jackson & Usher, 2005b; Phillips, 2007). Consequences also include anxiety disorder, substance abuse, and posttraumatic stress disorder (Quanbeck, 2006), Less job performance and less satisfaction (Baltimore; sofield & salmond, 2003). Other Emotional and psychological outcome includes fear, low self-esteem, and no confidence (Ventura- Madangeng, J., & Wilson, D. 2000). Health problems also result from continuing experience horizontal violence such as hypertension, Diabetes mellitus,

coronary artery disease, depression, (Sofield & Salmon, 2003).Not only health problems that result from horizontal level, but also emotional problems which Includes but not limited to low confidence, and low self-esteem (Nazarko, 2001). Physical consequences including: fractures bones, laceration, strains, backache, bruises, Wounds... etc. (Gerberich, Church, McGovern, Hansen, Nachreiner, & Geisser, 2004; Levin, Hewitt, & Misner, 1998; Lynch, Appelboam, & Mc Quillan, 2002). Theses out comes will lead to lose of work time and therefore lead to symptoms such as nausea, headache, and insomnia. For organization outcomes include but, not limited to nurses ask to be transferred to another location, strikes and walkout and increasing cost of the organization which comes from absenteeism of the staff, resignations, and increase load on other employees( Merecz,Rymaszewska, Moscicka , Kiejna,&Jarosz-Nowak,2006). Physical, emotional, and psychological outcomes compromise the quality of care delivered and thus increase cost for organizations. Other outcomes involve activities that require times such as creating new policies and procedures, providing consultation to the victims, change programs of the hospital after turnover (Cook, 2001; Diaz & Mc Millian, Laal; Duncan, Hyndman, Estabrooks, & Hesketh, 2001; Randle, 2003; Sommary en, 1994).

Tactics that contributes towards resolutions of the issue:

Number of steps can take so it acts as a resolution of workplace violence. Each workplace is different and it need to be assessed so it will be found out it vulnerability to violence. Then steps taken to prevent and minimize occurrence of the violence by knowing hazardous factors, so work safety carried out. This process need to evaluate periodically to evaluate its effectiveness (Mary & Gallant-Roman, 2008). It is the responsibility of the boss or manager to provide safety workplace for the employees. Administration of each hospital should address or determine types of violence such as bullying, harassment, and aggression. Therefore, it is the administration's responsibilities to stop such action. Solving the problem from Administration to employees through employers has called top â€"down approach (Mary & Gallant -Roman,

2008). Nurses must explain nursing procedures to the patient so he or she will not disorient or surprise and this turn precipitate violence attack, (Do not let violence happen to you, 2009,December ED Nursing, 16-17). Education program play an important role in preventing or reducing workplace violence. Supervisors taught first because they play an important role in the successful of the program, then come the turn of the employees. They must teach signs' of violence, prediction and respond to it. Education program about how to prevent violence should begin in nursing schools. Security individuals should be present when developing such programs (Mary & Gallant -Roman, 2008).


Violence in nursing workplace is one issue that facing health care sector especially nursing. It is problem that should not be overcome because will be spread more and more. A Lack of clear definition of violence make it difficult to report it and clear explanation of what is it put nurses in dilemma whether they are victims of violence or not, whether to report it or not. Among all health care personnel, nurses are the most health care provider who is vulnerable to and experience violence than any other providers of care. This is because of many reasons. Nurses experience violence from anyone who enter health care facilities, it could be any one of the community. Numbers of predisposing factors could start violence situations, which may include physical, emotional, and oral violence. Like any other problem facing nursing, violence has consequences and implications in nursing practice. Tactics, steps, and, programs had utilized to reduce, minimize, and prevent violence.