Assessment 3: Professional Accountability and Patient Safety
Defining the Issue: Violence from Patients towards Nurses:
In this discussion, I concern myself with ‘violence from patients towards nurses.’ It is important to note, from the onset, that violence meted to nurses by patients is one of the least discussed contemporary nursing issues. In the words of Stevenson, Jack, O’Mara and LeGris (2015, p. 32), “registered nurses (RNs), compared to other healthcare providers are at a higher risk of experiencing violence in the workplace that is initiated by patients and families.” In essence, violence from patients towards nurses includes any act of aggression initiated by the patient and (or) their relatives and friends and directed at the nurse. Acts of aggression in this case could include, but they are not limited to, grabbing, scratching, hitting, and in some cases shouting down the nurse in a threating manner. It is important to note that in some extreme instances, nurses have been killed by those they are attempting to take good care of. Patients likely to become violent towards nurses, as Ramacciati, Ceccagnoli, Addey, Lumini, and Rasero (2016, p. 23) point out include those having mental health issues and those under drug influence.
Significance to Nursing
According to Roche, Diers, Duffield, and Catling-Paull (2010, p. 14), the fact that nurses offer front-line service and are in close proximity to patients makes them prime “targets for interpersonal violence.” The services nurses provide to patients in the healthcare setting are largely hands-on. This puts them in close proximity to patients so that they can be able to not only administer medications, but also monitor the condition of patients. Further, nurses act as an important link between patients and doctors and maintain key records relating to the health condition and progress of patients. The relevance of nurses in the healthcare setting cannot, therefore, be overstated. Anything that disrupts the effective functioning of nurses in this setting is therefore a threat to the smooth functioning of the entire health system. It is important to note that as Stene, Larson, Levy, and Dohlman (2015, p. 114) point out, most violence from patients towards nurses is observed in the emergency room. Violent altercations in the emergency room can disrupt the flow of activities and effectively disadvantage other patients.
Nurses contend with a myriad of challenges in the discharge of their duties. Common challenges include working long hours, handing the anguish of family members and families following death of a loved one, ensuring that patients honor their treatment regimen even in those instances when they (patients) do not want to, etc. Violence at the workplace is yet another issue nurses have to contend with. It is important to note that as Stevenson, Jack, O’Mara and LeGris (2015, p. 37) point out, violence from patients towards nurses does take a toll on not only the physical, but also the emotional wellbeing of nurses.
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While physical effects could manifest in the form of physical injuries and disabilities, emotional pain includes stress and depression. As Arnetz, Hamblin, Essenmacher, Upfal, Ager, and Luborsky (2014, p. 340) point out, patient-related violence towards nurses need not be physical. As a matter of fact, the most common instances of violent and aggressive behavior towards nurses are verbal abuse, which in most cases takes the form of swearing (McNamara, 2010, p. 676). In instances where the said violence goes on for a significant period of time without being addressed, significant psychological trauma could set in. In some instances, emotional harm could be extensive and long-lasting – causing irreversible damage to the affected nurse’s wellbeing, in which case problems such as nightmares, palpitations, etc. become commonplace.
Violence from patients towards nurses could also end up affecting the nurse’s abilities to effectively perform their duties – effectively leading to suboptimal performance at the work setting, particularly as a result of emotional trauma. This could manifest itself via absent mindedness, etc. Also, when the effect of violence from a patient is extremely traumatic, the nurse may have to miss a few days (or weeks) of work (McNamara, 2010, p. 674). This effectively leaves their work centers and stations without adequate staffing. In essence, therefore, violence from patients towards nurses does have far reaching impacts on nursing.
Next, it should also be noted that when nurses are exposed to violent situations at the hands of their patients, this could result in changes in their attitude towards those they are supposed to take care of, and lead to loss of faith in this noble helping profession. As a matter of fact, as Cowen and Moorhead (2014, p. 190) observe, nurses have in the past changed profession as a consequence of constant exposure to violence at their places of work. In essence, this talent hemorrhage robs the profession of brilliant minds that could have been put to use to the benefit of patients and the entire nursing profession.
On the basis of the impact violence from patients towards nurses has on both nurses and the profession, there is need for healthcare institutions to embrace the relevant strategies in seeking to protect nurses from patient violence. These strategies will be explored elsewhere in this text.
Impact on Patient Safety
According to the World Health Organization –WHO (2018), patient safety has got to do with “the prevention of errors and adverse effects to patients associated with health care.” Generally, when nurses are subject of violence….....
Arnetz, JE, Hamblin, L, Essenmacher, L, Upfal, MJ, Ager, J & Luborsky, M 2014 ‘Understanding Patient-to-Worker Violence in Hospitals: A Qualitative Analysis of Documented Incident Reports’, J Adv Nurs, vol. 71, no. 2, pp. 338-348.
Cowen, PS & Moorhead, S 2014, Current Issues In Nursing, 8th edn, Elsevier Health Sciences, Missouri.
McNamara, SA 2010, ‘Workplace Violence and its Effects on Patient Safety’, AORN Journal, vol. 92, no. 6, pp. 677-682.
Ramacciati, N, Ceccagnoli, A, Addey, B, Lumini, E & Rasero, L 2016, ‘Interventions to Reduce The Risk of Violence Toward Emergency Department Staff: Current Approaches’, Open Access Emerg Med, vol. 92, no. 8, pp. 17-27.
Roche, M, Diers, D, Duffield, C, & Catling-Paull, C 2010 ‘Violence Toward Nurses, the Work Environment, and Patient Outcomes’, Journal of Nursing Scholarship, vol. 42, no. 1, pp. 13–22.
Stene, J, Larson, E, Levy, M & Dohlman, M 2015, ‘Workplace Violence in the Emergency Department: Giving Staff the Tools and Support to Report’, Perm J, vol. 19, no. 2, pp. 113-117.
Stevenson, K, Jack, SM, O’Mara, L & LeGris, J 2015, ‘Registered Nurses’ Experiences of Patient Violence on Acute Care Psychiatric Inpatient Units: An Interpretive Descriptive Study’, BMC Nurs, vol 14, no. 35, pp. 30-48.
Thomas, CM, McIntosh, CE & Mensik, JS 2015, A Nurse’s Step-By-Step Guide to Transitioning to the Professional Nurse Role, STTI, Indianapolis, IN
Wilson, S 2017, The Shocking Reality of Violence in Healthcare: And What We Can Do about It, Cengage Learning, Mason, OH.
World Health Organization (WHO) 2018, Patient safety, viewed 14 April 2018, http://www.euro.who.int/en/health-topics/Health-systems/patient-safety
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