Lateral Violence in the Emergency Department - Dissertation Example

Lateral Violence in the Emergency Department and Introduction Lateral violence can bedefined as an act of violence against ones’ peers (Becher and Visovsky, 2012). Lateral violence can be expressed in overt or covert ways. Overtly, acts of lateral violence consist of name-calling, gossiping, excessive blaming of fellows, putting down of others and unnecessary shouting at peers. Covertly, these may include unfair allocation of duties, roles and assignments, refusing to offer help when needed or asked for, ostracizing and exclusion of others, and ignoring (Corbin, Dumont and Brunelle, 2011). Lateral violence occurs in many settings workplace being one of them. One of the workplaces that have recorded alarming rates of incidences of lateral violence is the healthcare institutions’ emergency departments (Becher and Visovsky, 2012). This research study focuses on lateral violence in the Emergency Departments in the US healthcare system. Problem Statement Lateral violence is increasingly becoming a big problem in nursing. This has increased the prevalence of mental health conditions such as depression and schizophrenia among clinical nurses (Kathryn, 2011). When nurses are not happy their motivation and job satisfaction decrease. Eventually, these lead to higher employee turnover rates which increase the healthcare institution’s expenses and shortage of staff (Pai and Lee, 2011). Most importantly, lateral violence among nurses has compromised the quality of healthcare service by reducing the levels of optimal patient care (Kathryn, 2011). Lateral violence has especially been identified as more prevalent among nurses working in Emergency Departments (Corbin, Dumont and Brunelle, 2011). There are cases where a nurse has noted an error in medication administered by a fellow nurse but because of lateral violence within that setting that nurse fails to report this error, may be due to fear or revenge, this later leads to aggravated conditions for the patients. Many patients have experienced relapse in their conditions because one nurse refused to help another nurse claiming to be too busy when their help was needed or sought. Most of the decisions and medications nurses in ED make determine whether a patient lives or dies (Wanda and Sara, 2014). It is, therefore, crucial that the incidences of lateral violence between nurses working in the ED be kept at their minimum. Justification of the Research Lateral violence, as a concept, has been around for a long time. A lot of researches have been conducted on lateral violence in nursing practices. However, very little research has been conducted on lateral violence in the Emergency Departments (Corbin, Dumont and Brunelle, 2011). Research indicates that in the mid 1990s, the percentage of cases of lateral violence reported that emanated from the Emergency Departments was 9%. Fifteen years later, the rate of occurrence of lateral violence has doubled and now stands at 18% (Corbin, Dumont and Brunelle, 2011). Research further indicates that the Emergency Departments are just second to medical-surgical units in terms of prevalence of lateral violence. Nurses in medical-surgery units had a 23% chance of experiencing or witnessing lateral violence. This was followed by the Emergency Departments at 18%, critical care units at 12% and obstetric departments at 7% (Wanda and Sara, 2014). Among the nurses working in the Emergency Departments, 48% cited verbal abuse and being ignored as the main form of lateral violence (Becher and Visovsky, 2012). This occurred to newly promoted or admitted nurses. Among nursing students on nursing placements, 53% felt that the most common form of lateral violence perpetrated against them was being put down every time they do something wrongly and being unfairly criticized even when they are not at fault (Nursetogether.com, 2013). What is worrying, more than 52% of the nurses experiencing or witnessing lateral violence do not report or talk about it (Nursetogether.com (2013). The inability or unwillingness to vent causes depression, cardiovascular complications and a passive attitude that is detrimental to patients care. Some of the nurses believe that by ignoring a fellow nurse who needs their help to attend to a patient is revenge against that fellow nurse but, in reality, the nurse is rebelling against the patient and the oath they took. Ultimately, it is the patient that suffers the consequence of the lateral violence among the nurses. It is, therefore, critical to conduct a study to identify the reason for the increased incidence and prevalence of lateral violence in the Emergence Departments and identify measures to address the same. This study should provide meaningful insights to hospital administrators and nurse managers in Emergency Departments to help them better manage their employees. This, in turn, should help improve the quality of patient care and improve patient outcomes. Purpose of the Research The purpose of his research is to determine the risk factors of lateral violence on nurses working in Emergency Departments and how they affect the delivery of optimal patient care. In a bid to achieve this, the study seeks to achieve the following objectives: i) To determine the effects lateral violence has on a nurse’s psyche and consequent delivery of healthcare services. ii) To establish the reasons behind the higher prevalence and incidence of lateral violence among nurses working in Emergency Departments. iii) To determine the various responses to lateral violence as exhibited by the victims. iv) To establish some of the possible interventions that can be used to eliminate this vice in the healthcare system. v) To draw conclusions and make useful recommendations to policy makers and hospital administrators on how to alleviate lateral violence and, in effect, promote delivery of optimal care. Research Questions i) What are the effects of lateral violence on a nurse’s psyche and delivery of healthcare services? ii) What are the reasons behind the higher prevalence and incidence of lateral violence among nurses working in Emergency Departments? iii) How do victims of lateral violence respond? iv) What are some of the possible interventions that can be used to eliminate this vice in the healthcare system? Theoretical Framework This study is hinged on and informed by a number of theories. Being an exploratory study, the theories are meant to bring out the preconceived notions and the assumptions the study will be based on. This study will, first and foremost, be based on Conti-O’Hare’s Theory of the Nurse as a Wounded Healer. This theory has been used in similar studies in the past and is the most relevant nursing practice theory in this instance (Corbin, Dumont and Brunelle, 2011). This theory states that people choose the professions they chose because of the experiences they have had in the past. As such, most nurses chose to be nurses because they experienced pain in the past and wish to relieve fellow humans of their pain (Kathryn, 2011). The hurting experience and consequent trauma motivates these nurses to provide better, optimal patient care to their patients. This, however, hugely depends on whether and to what extent the nurse has been able to transform the traumatic experience and pain experienced in the past into self therapy (Wanda and Sara, 2014). This theory suggests that nurses have, at some point in their lives, had traumatic experiences which motivate them to pursue the nursing profession. The traumatic experiences are not forgotten but carried on throughout one’s life. So the nurses are inherently walking wounded individuals who are in denial of their woundedness (Wanda and Sara, 2014). If these nurses are placed in stressful situations and do not have a suitable avenue to vent they perpetrate this hurt on others, thus lateral violence. The victims, who are also walking wounded individuals, in turn perpetrate it on others. The cycle of lateral violence is thus created and hard to break. This happens when the individuals have not effectively managed their pain and hurt. However, if the pain is identified, transformed and transcended, the nurse finds healing. The nurse transforms from being a walking wounded individual to a wounded healer offering quality healthcare to patients because of better understanding of the patient’s hurt and need for care (Wanda and Sara, 2014)). The nurse is then able to use this healing and emotions it evokes to deliver the most optimal and compassionate patient care to the patients. This theory is informative since it shows the origin of lateral violence among nurses. It is also insightful since it shows the different effects lateral violence can have on individuals. The assumptions that human beings experience trauma at one point in their lives which then shape their decision making and outcomes in life is congruent with other nursing theories (Pai and Lee, 2011). The assumption that a person has the power to determine their reaction on whether to make therapeutic use of self or not is also central to this study as it determines how nurses react to lateral violence and how this is impacted on the quality of healthcare services offered. This theory, in essence, provides that the capability to deal with the traumatic experience and lateral violence determines the ability of a nurse to optimally care for patients. This study is also hinged on the various theories of needs and motivations such as Maslow’s Hierarchy of Needs theory and Herzberg’s Two Factor theory. These theories explain that human being have an intrinsic need to have their needs fulfilled and that the extent that the needs are fulfilled determine their job motivation and consequent job satisfaction (Kathryn, 2011). These two factors are directly proportional to employee performance and inversely proportional to employee turnover rates. Maslow’s theory of needs explicated the five stages of needs that an employee will seek to satisfy and in the process achieve job satisfaction. They included the psychological needs, safety needs, social needs, esteem needs and self-actualization needs in that order (Pai and Lee, 2011) . A nurse that experiences a favourable working environment such as cooperation and help will be motivated to work and will be better placed to care for patients. The reverse is also true. Definition of Terms i) Walking wounded- These are nurses who experienced pain and traumatic experiences in the past but are yet to address this pain and hurt. They live in denial and when facing life stressors they vent on their peers and others consequently leading to negative results in their work. ii) Wounded healer- These are nurses who have experienced pain and traumatic experiences in the past but have already identified and resolved and risen above their traumatic experiences. These individuals are capable of using their past pains and traumatic experiences as motivation towards offering better healthcare services to their patients. Summary This chapter is the introductory chapter of this study. In the statement of the problem the study has identified that lateral violence among nurses working in Emergency departments has now become a big problem in the US healthcare system (Wanda and Sara, 2014). This has necessitated brainstorming on what are the possible reasons for this phenomenon and how it and its effects can be alleviated to ensure patients receive optimal patient care. This chapter, lastly, identifies the theoretical framework for this study. Through the framework, the study identifies the most critical assumptions upon which this study is based. The assumption is that all nurses are walking wounded individuals and have been motivated by their traumatic experiences to take to nursing profession (Kathryn, 2011). Nurses who are able to transform their hurt and traumatic into therapeutic use of self become better nurses. References Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. Journal of Medical Surgery, 21(4), 210-213. Corbin, C., Dumont, C., & Brunelle, D. (2011). Defeating horizontal in the emergency department. American Nurse Today, 6(10), 91-95. Kathryn, A. (2011). Workplace aggression and violence: Nurses and midwives say NO. Australian Nursing Journal, 19(1), 26-29. Nursetogether.com (2013). Break the spell and end lateral violence in nursing. Retrieved from http://www.nursetogether.com/break-the-spell-and-end-lateral-violence-in-nursing Pai, H., & Lee, S. (2011). Risk factors for workplace violence in clinical registered nurses in Taiwan. Journal of Clinical Nursing, 20, 1405-1412. Wanda, C., & Sara, J. (2014). Lateral violence in nursing and the theory of the nurse as wounded healer. Online Journal of Issues in Nursing, 18(4), 1 Read More