Violence in the workplace is an issue that is not always discussed yet it’s absence is an integral component in the vitality of any organization. Even in this professional setting, there are cases and phenomena of workplace violence. Often, what are widespread are instances of nurses being “bad” and violent to patients. What nurses do not speak up about is workplace violence that is directed at them. Nurse-to-patient abuse is reported but there also exists patient-to-nurse violence that is not spoken about. According to the American Nurses Association’s Code of Ethics, there is a clause that states “the nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety…” (2011). Nurses are in a position to give care, with compassion and a warm heart. Sometimes due to different circumstances, nurses are met with resistance, anger, hatred, and “transgressive” behavior that embarrass and demoralizes, making certain nurses feel undervalued for giving all their energy and care. Nurses are invaluable advocates for their patients. In the same respect, nurses must be advocates for themselves. Vandecasteele, Debyser, Van Hecke, De Backer, Beeckman, & Verhaeghe conducted a qualitative research study in 2015 to gain perspective in “transgressive” behaviors in care relationships.
Vandecasteele et al. conducted this study with certain objectives to gain insight into patient transgression and how nurses perceive it. The study asks two main questions:
- “What behavior in the patient-nurse relationship is perceived as transgressive?”
- “What processes or mechanisms influence perceived seriousness of transgressive behaviour?” (2015)
It was a qualitative research study according to grounded theory. Sampling was purposive of eighteen experienced nurses and sample size was determined by data saturation. Vandecasteele’s study methods included semi-structured interviews at a “private at the location of their [interviewee] choice,” confidentiality measures were maintained, accuracy ensured, reflexivity practiced, and investigator triangulation used for credibility and conformability (Vandecasteele et al, 2015).
The results showed that nine factors were identified that affected nurses’ perceptions of transgressive behaviour in care relationships. These factors were divided into two subdivisions- four “determining” factors (a limit exceeded, which caused a behavior to be perceived as transgressive) and five “regulating” factors (factors that influence the regulation of the meaning of the experiences). The findings include:
“The degree of control that nurses experience over the provision of care, the perceived degree of patient acceptance of organizational and ward rules, the perceived degree of gratitude and recognition expressed by the patient and the perceived extent of patient regard for the nurse as a person… [and] a trusting relationship between patients and nurses, the extent to which patient perspectives were understood and the way transgressive behaviour was managed, … the role of the team and head nurse and the influence of ward culture and habits.” (Vandecasteele et al, 2015).
The study findings relate to the investigation of how nurses experience workplace violence inflicted upon by the patients. Vandecasteele writes: “Nurses regard the role of a good nurse as providing proper care to patients. Consequently, they consider it their responsibility to ensure that the patient receives proper care” (2015). Theoretically, nurses arrive to work ready to take on any challenges that may come their way. Nurses obtain an education, go through training, and even continue their education to be able to maintain competency for safe care with compassion. The reality is that by the same token those patients are human; nurses are human, as well. As nurses take an oath to “do no harm” and to “do good,” the reward for providing care is usually intrinsic, where one feels good simply for “doing good.” When a nurse is met with what can be argued as unappreciative, disrespect, and sometimes hate, the wall of morale suffers a blow leading to burnout, exhaustion, and the loss of esteem.
Study respondents stated different viewpoints in accordance with Vandecasteele’s findings. A respondent stated: “…I do my best and the family and patient think, I don’t work enough. I’m not fast enough, patients are not well cared for, they have to sit up for a long time … While you know you did everything you could do . . . That really hurts . . .” (Vandecasteele et al, 2015).
Violence and abuse are not justified. It is a deplorable act for a nurse to be violent to their patient and verbal, sexual, physical, and emotional abuse has legal repercussions and is never tolerated. In comparison, nurses may suffer the same violence and abuse from certain patients and it is often unreported, tolerated, and kept quiet. It is not acceptable for the nurse to be abusive to a patient, nor is it acceptable for a patient to be abusive to a nurse. This is an issue in professional nursing that is not discussed often enough, which can have negative effects on patients, the facility, and the health of the nurse. Nurses must advocate for controls to workplace violence, especially from the patient to nurse.
References
American Nurses Association. (2015). Code of Ethics for Nurses. Retrieved from http://www.nursingworld.org/DocumentVault/Ethics_1/Code-of-Ethics-for-Nurses.html
Vandecasteele, T., Debyser, B., Van Hecke, A., De Backer, T., Beeckman, D. & Verhaeghe, S. (2015) Nurses’ perceptions of transgressive behaviour in care relationships: a qualitative study. Journal of Advanced Nursing 00 (0), 000–000. doi: 10.1111/jan.12749. Retrieved https://www.researchgate.net/publication/280873999_Nurses’_perceptions_of_transgressive_behaviour_in_care_relationships_A_qualitative_study
