Horizontal violence among nurses working in intensive care environments within the private healthcare sector

Rust, Hanri (2018-03)

Thesis (MCur)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Background: Nurses are three times more likely to become victims of abuse in the workplace than any other profession, with 65% of American nurses having reported being abused in the workplace in 2008. Horizontal violence has a detrimental effect on a victim’s psychological and physical health and can lead to a decrease in the quality of care a patient receives when being cared for by a nurse who is a victim of horizontal violence. Aim: The aim of the study was to investigate horizontal violence among nurses in order to quantify and describe this phenomenon as it occurs in intensive care environments. Methods: This study applied a quantitative descriptive survey design. Control over the relevant research topic were over a period of five months from 2016 to 2017. A two-stage cluster sampling design was applied to include hospitals with intensive care environments in the private healthcare sector within the Cape Metropole (N = 13, n = 6) and participants who met the study inclusion criteria (N = 182, n = 118). The participants completed a self-administered questionnaire developed from relevant contemporary literature to quantify and describe the existence and effect of horizontal violence among nurses working in these environments. The data were analysed using the statistical package Stata version 14.2 for Windows. The data collected were organised by using frequency distribution in which the number of times each event occurs was counted. Results: A response rate of 65% was obtained (N = 182, n = 118). The results showed that both covert and overt abusive behaviours occur among nurses working in intensive care units. The most common form of covert abusive behaviour was a person being ignored by his or her colleagues (n = 35, 32%) and that of overt abusive behaviour was colleagues complaining about one another in the workplace (n = 25, 21%). Both covert and overt abusive behaviours occur daily; however, more participants (n = 68, 60%) experienced some form of covert and/or overt abusive behaviour at least a few times a year. The participants reported having negative psychological effects and physical symptoms, such as negative internalised feelings about self and headaches, as an outcome of experiencing abusive behaviours. Quality of patient care is seen to be negatively affected by horizontal violence due to a person’s fear of being victimised (n = 56, 46%). Further, horizontal violence is seen as a trigger to the victim making errors (n = 51, 46%) as well as choosing to engage in unsafe practices during patient care (n = 44, 36%), or to leave employment (n = 23, 16%). The participants identified that both colleagues and supervisors commit abusive behaviours. Conclusion: Horizontal violence is experienced by all categories of nurses working at patients’ bedside in intensive care environments in the private healthcare sector within the Cape Metropole. Nurses experienced both covert and overt abuse in the workplace and suffered from a variety of effects such a professional discouragement, internalised negative feelings and even physical symptoms such as headaches and abdominal pain. For some nurses, the only way to end this cycle of abuse was to resign from their current employment. The quality of patient care delivered by abused nurses was also reported to be affected in terms of unsafe practice, with nurses putting not only their patients but also themselves at risk.

AFRIKAANSE OPSOMMING: Agtergrond: Die kanse vir verpleërs om slagoffers van mishandeling in die werkplek te wees, is drie keer dié van enige ander professie, met 65% van Amerikaanse verpleegpersoneel wat mishandeling in die werkplek gerapporteer het in 2008. Horisontale geweld het ʼn nadelinge uitwerking op ʼn slagoffer se sielkundige en fisiese gesondheid en kan lei tot ʼn afname in die gehalte van versorging wat ʼn pasiënt ontvang wanneer versorging gegee word deur verpleegpersoneel wat ʼn slagoffer van horisontale geweld is. Doel: Die doel van die studie was om horisontale geweld onder verpleegpersoneel te ondersoek ten einde hierdie verskynsel te kwantifiseer en te beskryf waar dit in intensiewesorg-omgewings voorkom. Metodes: In hierdie studie is ʼn kwantitatiewe beskrywende opname-ontwerp toegepas. Data is oor ʼn tydperk van vyf maande in 2016 tot 2017 ingesamel. ʼn Tweefase-trosstreekproefontwerp is toegepas om hospitale met intensiewesorg-omgewings in die privaat gesondheidsorgsektor in die Kaapse Metropool (N = 13, n = 6) en deelnemers wat aan die studie se insluitingskriteria voldoen het (N = 182, n = 118) in te sluit. Die deelnemers het ʼn selftoegediende vraelys ingevul wat op grond van toepaslike onlangse literatuur ontwikkel is om die voorkoms en gevolge van horisontale geweld onder verpleërs wat in hierdie omgewings werk, te versyfer en te beskryf. Die data is met behulp van die statistiekpakket Stata, weergawe 14.2 vir Windows, ontleed. Die ingesamelde data is georden met behulp van frekwensieverspreiding waarvolgens die getal kere wat ʼn gebeurtenis voorgekom het, getel is. Resultate: ʼn Responskoers van 65% is verkry (N = 182, n = 118). Die resultate het getoon dat sowel bedekte as openlike mishandelende gedrag onder verpleërs voorkom wat in intensiewesorg-eenhede werk. Die algemeenste vorm van bedekte mishandelende gedrag was dat ʼn persoon deur sy of haar kollegas geïgnoreer word (n = 35, 32%) en dié van openlike mishandelende gedrag was kollegas wat oor mekaar in die werkplek kla (n = 25, 21%). Sowel bedekte as openlike mishandelende gedrag kom daagliks voor, maar meer deelnemers (n = 68, 60%) het egter een of ander vorm van bedekte en/of openlike mishandelende gedrag ten minste ʼn paar keer per jaar ervaar. Die deelnemers het negatiewe sielkundige gevolge en fisiese simptome, soos negatiewe geïnternaliseerde gevoelens oor hulself en kopseer, as ʼn uitkoms van die ervaring van mishandelende gedrag gemeld. Dit blyk dat die gehalte van pasiëntesorg negatief deur horisontale geweld beïnvloed word weens vrees om geviktimiseer te word (n = 56, 46%). Voorts lei horisontale geweld tot slagoffers wat foute begaan (n = 51, 46%) en ook kies om onveilige praktyke tydens pasiëntesorg uit te voer (n = 44, 36%), of om te bedank (n = 23, 16%). Die deelnemers het gemeld dat sowel kollegas as toesighouers aan mishandelende gedrag skuldig is. Gevolgtrekking: Horisontale geweld word deur alle kategorieë verpleërs ervaar wat pasiënte in intensiewesorg-omgewings in die privaat gesondheidsorgsektor in die Kaapse Metropool versorg. Verpleërs ervaar sowel bedekte as openlike mishandeling in die werkplek en ly onder verskeie gevolge, soos professionele ontmoediging, geïnternaliseerde negatiewe gevoelens en selfs fisiese simptome soos kopseer en maagpyn. Vir sommige verpleërs is die enigste manier om hierdie kringloop van mishandeling te beëindig om te bedank. Die gehalte van die pasiëntesorg wat deur mishandelde verpleërs gelewer word, word ook benadeel met betrekking tot onveilige praktyke, met verpleërs wat sodoende nie net hul pasiënte nie, maar ook hulself in gevaar stel.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103457
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