Violence Against Nurses &

Nursing Students
Breanna Doherty, Alannah Hewitt, Alicia Jeffery, Emily Johnson, Natalie Luzny
March 26, 2018
Description
- Patient instigated violence is the most prevalent type of
assault and harassment against nurses
- Violence includes both physical and verbal abuse
Physical Assault: includes hitting, slapping, hitting, kicking,
punching, spitting at, grabbing, holding down, and strangling
another person (2, 3, 4)
Verbal Assault: includes insensitive comments, rude remarks,
insults, incivility, cursing, raising voice, threatening, verbal abuse
(2,3)
Scope of This Issue?
- Nurses are 3 times more likely than any other profession to experience
violence(9)
- Violence occurs in all areas of health care
- Ontario-wide study found that 68% of all nurses experienced at least one
violent act in the past year (3)
- 20% have experienced 9 or more acts of violence against them(3)
- Verbal abuse is the highest form of violence experienced, with 85% of RNs and
RPNs experiencing it in the last year
- Most recent report found 4000 reported incidents of violence from nurses in
Canada between 2008-2013 (4)
Why We Chose This Issue
- Such a widespread and prevalent issue
- “Nursing students have similar experience to registered staff, included
experiencing violence” - RNAO(9)
- RNAO is concerned with students assimilating these incidents as expected
components of being a nurse and perpetuating the issue
- One study found that 50% of nursing students experienced some form of
violence, with another study estimating 60% (8)
- Violence against nurses & nursing students has detrimental effects
Cont’d
1. Negative effects on the nurse/nursing students
a. Increased stress, risk for PTSD, decreased satisfaction, increased absenteeism & turnover,
negative working environment (1, 7)
2. Negative effects on patients
a. Decreases productivity of nurses and decreases quality of care for patients (1,7)
3. Increases the cost of health care
a. High lost-time injury rate, compensation, absenteeism (2, 3)
4. Violence against nurses/nursing students can be reduced
a. Lack of effective leadership, underreporting, lack of policy commitment all increase violence (1,4)
Our plan will address these areas in order to reduce violence against nurses and
nursing students
Havelock's Theory of Change (10)
Havelock's Theory of Change
1. Relationship: A relationship must be developed between all stakeholders where
communication is two-way and honest.
2. Diagnosis: There must be a decision as to whether or not change is needed and
how to proceed with the change.
3. Acquire Resources for Change: Gathering information and data needed for the
change process.
Havelock's Theory of Change, cont’d
4. Selecting a Pathway: Choose the path of change and begin implementation.
5. Establish and Accept Change: Change must be accepted and become part of the
new behavior.
6. Maintenance and Separation: Monitor the change and continue the cycle. (10)
Why This Model?
● This model matches our plan as it helps to focus on the actual
steps of a plan, and how to integrate multiple steps together to
bring about change
● Not a top-down model, it’s a collaborative model that focuses
on empowerment of everyone involved
● It’s also a cycle so you can enter and re-enter at any stage
● Also mimics the nursing process (ADPIE) so it’s easy for
nurses to understand and apply
Our Plan
1. Relationship: Establish a relationship with stakeholders and followers within
TFSON and the clinical placements
2. Diagnosis: Use of literature, past experiences, surveys and data from TFSON about
reported incidences and current policies surrounding this issue.
Why change is necessary:
- Prevalent issue within nursing
- No TFSON policy
- Lack of education in our curriculum
Our Plan, cont’d
3. Acquire Resources for Change:
- Develop plan of how to proceed with change
- Create & integrate policy into TFSON handbook
- Implement a “marking system”
- NVCI training mandatory for 1st year
- Rules about buddy system & patient assignments
- Integrate education and awareness about potential
violence and aggression within nursing
- Provide resources when incidents occur
- Talk with stakeholders about logistics of
implementing plan
- Getting TFSON on board, and associated
hospitals/facilities
- Develop budget and acquire other necessary
resources
 Our Plan, cont’d
4. Selecting a Pathway:
Implement Policy into Incorporate Education About
Handbook Issue Into Classes
Sept. 2018 Sept., 2019
Immediately Jan. 2019
Implement Buddy System, 1st Incorporate Education About
Year NVCI Training, Marking Issue Into Curriculum
System and Assignment Rule
Our Plan, cont’d
5. Establish and Accept Change:
- Implement our plan
- Use survey data and number of reported incidences to evaluate effectiveness of
plan after each step
6. Maintenance and Separation:
- Ensure effectiveness and sustainability of plan
- Monitor if outcomes are being achieved
- Implement at other locations
- Start cycle again if large changes are necessary
Expected Outcomes
- Increased reporting of incidents of violence
- Tracking and monitoring of violence against Trent nursing students
- Increased awareness and education about violence and its prevention
- Policy implementation to mitigate violence and aggression and outline actions
- Implementation of actual systems to decrease violence
- Eventually see a decrease in the # of violent acts against nurses, and a decrease
in the severity of injuries
- Reduced consequences of incidences and higher perceived safety
Issues & Barriers
- Underreporting/ignorance of violence and
aggression
- Hospital/TFSON does not agree with the
policy
- Lack of students to implement the buddy
system
- What people actually define violence &
aggression to be
- Financial costs
- Lack of staffing
Strategies for Issues & Barriers
- Empowerment
- Help increase awareness & education, explaining, putting systems in place so people can take
action and advocate for themselves, providing support
- Advocacy for policy-making and including information in nursing education
programs
- Increasing own knowledge on the subject
- As a leader you must be educated about the issue in order to raise awareness/make change
- Leading by example
- TFSON carries through on reporting, helps to maintain followership and support, no judgment
toward students reporting
- Maintaining open communication with stakeholders, students and TFSON
- Create common terminology (i.e., definition of violence)
- Be willing to listen and receive suggestions for improvement
Conclusion
- Violence and harassment against nurses is highly prevalent in the workplace,
regardless of the setting
- By incorporating Havelock's Theory of Change, there is a way to decrease the
violence and harassment nurses & nursing students face
- Our plan includes advocating and implementing policy, education, increasing
awareness, and practical systems
- Potential barriers include: under-reporting, disagreement between stakeholders,
lack of resources
- Strategies to overcome them include: advocacy, empowerment, maintaining
followership, open communication and leading by example
DISCUSSION
Has anyone had experience or seen acts of violence
against nurses/other students during your time as
a nursing student?
Do you feel like aspects of our plan would improve
violence against nursing students and other
nurses? Which ones and why?
Do you think anything else would help decrease
violence against nurses/students?
What else would you include in our plan?
Do you think this plan is applicable to other types
of violence against nurses? (i.e., nurse-nurse,
family-nurse)
 References
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Nursing Scholarship, 49(2), 236-243. doi: 10.1111/jnu.12272
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Journal of Nursing Studies, 51, 72-84. doi: 10.1016/j.ijnurstu.2013.01.010
3. Mojtehedzadeh, S. (2017, November 5). Violence against health-care workers “out of control,” survey finds. The Toronto Star.
4. Cribb, R. (2015, October 31). Workplace violence makes nursing one of Canada’s most dangerous professions. The Toronto Star.
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https://www.nursingeconomics.net/ce/2013/article29059066.pdf
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9. Registered Nurses’ Association of Ontario. (2008). Position statement: Violence against nurses - “zero” tolerance for violence against nurses and nursing students. Retrieved
from http://rnao.ca/policy/position-statements/violence-against-nurses
10. Myers, C. E. (2017). Elements of Change. Perspectives in Learning,16(1), 15-18. Retrieved from
http://csuepress.columbusstate.edu/cgi/viewcontent.cgi?article=1007&context=pil