Prof. (Mrs.) Karesh Prasad

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Prof. (Mrs.) Karesh Prasad Principal Peoples
College of Nursing R. C. Bhopal (M.P)
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(No Transcript)
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• DARK SIDE OF NURSING VIOLENCE IN WORKPLACE

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INTRODUCTION

• Half our waking hours are spent in the workplace.
  Hence the workplace environment is very
  important.
• Violence hostility is on increase in our day to
  day life. People burst into volatile actions on
  petty issues.
• Violence has become part parcel of our
  mechanized competitive world.
• Violence in workplace is a societal problem and a
  global issue.

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• The newspaper magazines are full of instances
  highlighting increasing crime against women.
• Weather you blame the T/V, media or downfall of
  moral values in the society the women has to face
  the wrath. Take the Eg of Indira Gandhi,
  Benazir Bhutto they too became victims of
  violence in their work place and laid their lives
  for the nation.

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• Florence Nightingale would have been shocked
  seeing the pathetic state of nurses who are
  continuously faced with violence in workplace.
• How can one forget Aruna Shan Baugh a nurse in
  KEM Hospital Mumbai, who was raped crippled by
  a hospital staff?
• Nurses are round the clock with patients hence
  they are the first ones to face the wrath of
  patients relatives.

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• Violence in nursing is a matter of great concern
  for health care provider. Violent actions often
  seen are
• Young psychiatric patient who hallucinates
  begin to bite, scratch kick whoever walks up to
  them
• Serious patients family/relative in waiting
  room demands information storms into treatment
  area pushing nurses others staff aside.
• A drunken patient who wants to fight his way out
  of hospital punching spiting on everyone that
  gets in his way

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• We see these scenarios as part of the job. As per
  Bureau of labor statistics (2001) all occupations
  are exposed to violent crime (12-6 per 1000
  workers) but personnel in the health social
  service sector are exposed to greater violence (
  Mental Health professional 6 of .2, Nurse 21.9
  physician 16.2 per 1000 workers).
• The incident may be much higher as many
  incidences go unreported as the
  employer/employees save their negative image.

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• The National Safety Council believes that safety
  in the workplace is the responsibility of both
  the employer and the employee.
• Threats to safety in the workplace are from
  exposure to potential violence from.
• Violence from patients.
• Violence from other staff members.
• Violence from nursing staff.
• Violence from relatives/visitors.
• Lethal, chemical, injections etc.

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• These acts may be from External parties like
  uncivilized/robbers/self styled majnus. Internal
  parties like patients, relatives other
  professional members.
• Work Place Violence leads to Low worker morale,
  high job stress, high turnover Low trust between
  management co worker.

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• According to American Nurses Association
• Abuse harassment of nurses in professional
  association in all work environments in whom
  nurses practice, including abuse, harassment,
  based on age, color creed, durability, gender,
  health states, life style nationality, race
  religion or sexual orientation shall not be
  tolerated

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STATEMENT OF THE PROBLEM

• A study to assess work related violence faced by
  nurses working in selected hospital of Bhopal in
  Madhya Pradesh.

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OBJECTIVES

• To assess the violence faced by nurses in their
  work.
• To identify the areas facing maximum violence in
  workplace.
• To assess the various methods used to tackle
  violence by nurses.
• To suggest remedial measures to overcome
  workplace violence

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Study Population

• The study population consisted of nurses who were
  presently working in two selected hospitals in
  Bhopal. Systemic Random sampling was done. So
  every 10 nurses were selected out of total 500
  nurses working in two selected hospital of
  Bhopal. The total sample was 50.

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Definition

• Violence in the workplace include any activity
  (including traveling) associated with job or
  events that occurred in the work environment
  involving the intentional use of physical force
  or emotional abuse against an employee resulting
  in physical or emotional injury.

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Physical Assault

• when one is hit, slapped or kicked, pushed,
  grabbed, homicide use of weapons such as fire
  sexually assault or otherwise uses physical force
  intended to injury.

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Threat

• Use of words gestures or action with the
  intention of frightening, or harming (physically
  or otherwise) body language, written threats.

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Muggings

• Assaults conducted by surprise with intention to
  rob.

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Sexual Harassment

• occurred when one experienced any type of
  unwelcome sexual behavior (words or actions) that
  created a hostile work environment.

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Assault

• It is an unlawful attempt, coupled with present
  ability to commit a violent injury on the person.

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Verbal Abuse

• When another person yelled, engaged in name
  calling or used other words, intended to control
  or hurt.

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Bullying

• Any willful threat to inflict injury on another
  person or any intentional display of force as
  would give the victim reason to fear or expect
  immediate bodily harm. Bullying happens when
  someone hurts or scares another person being
  bullied has a hard time defending himself/herself
  .This happens getting certain people to gang on
  others, teasing people in a mean way.

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Lateral or Horizontal Violence

• This involves interpersonal conflict, harassment,
  harsh criticism, sabotage
• abuse among nurses.

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Data Collection

• After obtaining formal administrative approval
  data was collected from 50 staff nurses working
  in Bhopal Memorial Hospital and Research Centre
  and Peoples Hospital and Research Centre by
  Probability Sampling Technique. Data was
  collected by giving self-introduction and
  establishment of rapport with the subject. The
  subjects were interviewed personally by
  investigator by using structured interview
  schedule.

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Data Analyses

• Plan for data analysis was chalked out by
  employing descriptive statistics. The frequency
  and percentage computation was done.

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Table No. 1. Age wise distribution N50
Table No. 1 describe age wise distribution. It
shows that majority 31 (62) of the Nurses belong
to 25 to 30 age group. Where as 14 (28) were les
then 25 years of age. Only 4 (8) Nurses were
more than 35 years of age.
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Age wise Population of India(Source Employment
News 22-28 Dec 2007)
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Table No. 2 Sex wise Distribution N50
Table No. 2 describe sex wise distribution. It
shows that majority 40 (80) of the Nurses were
female Where as 10 (20) were male.
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Table No. 3 Marital status wise
distribution N50

• Table No. 3 describes marital status wise
  distribution of the Nurses majority 33 (66 ) of
  the Nurses were single. This shows that Nurses
  are getting married late. The no. of married
  nurses was 17 (34 ).

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Table No. 4 Income wise distribution N50

• Table No. 4 describes Income wise distribution of
  the Nurses. Majority 23 (46 ) were earning up to
  Rs. 7000/- . Non of the nurses where getting more
  than Rs. 7000/-. This indicate that nurses are
  paid low.

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Table No. 5 Place of residence N50

• Table No. 5 describes place of residence wise
  distribution of the Nurses. Majority 31 (62 )
  were residing with in the campus where as 13 (26
  ) of the nurses were staying 6-8 Km away from
  their place of work

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Table No. 6 Native place wise distribution
N50
Table No. 6 describes native place wise
distribution of the Nurses. Majority 14 (28 )
nurses belonged to Madhya Pradesh where as 12 (24
) of the Nurses belonged to Kerala. This
indicate that female from Madhya Pradesh are
still not coming forward for nursing.
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Table No 7 Duration of Employment N50
Table No. 7 describes duration of employment wise
distribution of the Nurses. Majority 48(96 ) of
the Nurses were employed for les than 5 years
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Table No. 8 Place of work N50
Table No. 8 describes place of work wise
distribution of the Nurses. Majority 40 (80 ) of
the nurses were working in private hospitals.
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Table No. 9 Education Qualification
N50
Table No. 9 describes educational qualification
wise distribution of the Nurses. Majority 46 (92
) of the nurses basic qualification was 102.
which is the entry qualification required in
nursing.
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Table No.10 Professional Qualification N50
Table No. 10 describes professional qualification
wise distribution of the Nurses. Majority 34 (68
) of the nurses were having GNM qualification.
Their were 15 (30) nurses who were B. Sc. (N).
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Table No 11 Have you faced violence during last
one year of your service? N50
Table No.11 describes if they faced violence
during their services. Majority 49 (98 ) of the
nurses accepted that they faced some form of
violence during their service.
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Table No 12 Area of work where they faced
violence. N50
Table No.12 describes if they faced violence
during their services. Majority 24 (48 ) agreed
that they faced violence while working in ICU.
Where as 12 (24 ) faced violence while working
other then ICU 10 (20 ) agreed that they faced
violence while they were working in emergency.
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Table No. 13 Violence directed towards.
N50
Table No. 13 describes that majority 27 (54 )
the violence was directed towards staff. Only 8
(16 ) the violence was directed towards patients
and others
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Table No. 14 Who was the Assailant ?
N50
Table No. 14 describes that majority 27 (54 )
visitors were the assailants where as 13 (26 )
patients were assailants.
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Table No. 15 What was the no. of Assailant ?
N50
Table No.15 describes that majority 25 (50 ) of
the visitors who were single were the assailants.
Assailant 21 (42 ) were in group.
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Table No. 16 what was the predisposing factor in
the violent attack? N50

• Table No.16 describes that majority 14 (28 )
  were violent due to dissatisfaction to care in
  parted. 12 (24 ) became violent due to long
  waiting hours. Where as 10 (20 ) became violent
  due to reaction after death.

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Table No. 17 what was the violent incident?
N50
Table No.17 describes that majority 42 (84 )
stated that they faced verbal abuse where as 8
(16 ) informed that they were physical abused.
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Table No. 18 what was the extent of injury caused
to you? N50

• Table No.18 describes that majority 44 (88 )
  were caused injury other than face and bruises.

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Table No. 19 How was the assailant disposed ?
N50

• Table No.19 describes that majority 23 (46 )
  that assailants stayed in premises. Where as 15
  (30 ) assailants left the side on their own.

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Table No. 20 How was the incident terminated?
N50

• Table No.20 describes that majority 25 (50 )
  that the violent incident was diffused at its own
  where as 18 (36 ) said that the incident was
  terminated through means other than police or
  arrest.

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Table No. 21 what help was sought by you to
tackle the violent incident?
N50

• Table No.21 describes that majority 18 (36 )
  informed that they called the nursing supervisor
  where as 14 (28 ) called hospital administrator
  and 12 (24 ) called the security guard.

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Table No. 22 what action was taken by hospital
administration? N50

• Table No.22 describes that majority 32 (64 )
  complaint was lodged where as 15 (30 ) informed
  that assailant was handed over to security.

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Improving the working condition

• Education and training.
• Reducing Risk.
• Increasing protection in workplace.
• Rules regulation and policies.

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Understanding Common causes of violence in
workplace

• Death of patient
• Non availability of expected care.
• Concern stream of family member due to
  patients critical condition.
• Family member anger related to hospital policy.
• Long waiting time is clinically.
• Lack of adequate security personnel.

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• Lack of training regarding dealing stressful
  situations.
• Prevalence of assault weapon with patients/ their
  family members.
• Increasing use of hospitals by police criminals
  during acute disturbed phone.
• The increase in number of discharge of acute
  chronic mentally ill patients.
• Increase in the number chronically ill pts, of
  drug /alcohol abuses, disturbed families.

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• Shortage of staff especially when the activities
  in ward are more like meal time, visiting home,
  shifting of patients.
• Lack of training among staff regarding how to
  identify, recognize, hostility managing bizarre
  behavior.
• Isolated workplaces.
• Failure of electricity lack of backups or
  properly lit areas like corridors, staircases,
  bathroom lifts etc.
• Inadequate untrained security.

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• Exchange of money.
• Mobile workplace.
• Working in criminal setting/High crime area
• Working alone in small numbers.
• Working late at night or during early morning
  hours.
• Working in stressful enviournment.
• Working with unstable or volatile person in
  health care/Community setting.
• Lake of adequately trained/Armed security guards.
• Patients pain discomfort.
• Congested spaces.

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Prevention

• Every organization big or small should have a
  programme for safety security of its personnel.
• This information should be preferably written
  down policy of institutions.
• Their information should be made communicated to
  its employer at.

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• Safety bells in corridors for emergency
  situation.
• Burned / grills in welcomes walls of female
  wards/
• Additional female guards with nurses on night
  shift.
• Public education

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Training

• Nursing superintendent
• Manager/Supervisor
• Administrative staff.
• Security personnel.

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Content of Training

• Workplace violence prevention policy.
• Risk factors or causes of assent
• Early recognition / weaning sign.
• How to avoid / aggressive situation.
• How to handle hostile situation
• Policy procedure for reporting situation.

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Professional Etiquette
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Body Language

• Your body language often reveals more about your
  than verbal communication. Be conscience of it,
  because it is always being observed.
• Good posture displays confidence
• Dont slouch stand and sit upright
• Dont fidget it is annoying and a sign of
  boredom
• Keep hands away from your mouth when speaking

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• Honor others personal space
• Break nervous habits, such as gum chewing,
  drumming fingers, hair twirling, nail biting,
  etc.
• Dont show the soles of your shoes while sitting,
  especially in the company of individuals from
  other countries

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Dress Code - Women

• Use fragrances sparingly
• Makeup and jewelry should be kept simple
• If the men are wearing ties, you should be
  wearing hose
• Avoid all clothing that is too revealing or too
  restrictive
• Dont wear heels so high that you are unsteady
  (common height 2-3)
• Nails should not be more than ¼ in length

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A Good Conversation

• Is polite
• Is a good listener
• Puts others at ease
• Can discuss numerous issues
• Asks good questions
• Never interrupts

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Telephone Tips

• Tone and voice clarity are more important than
  the words you use
• Smile speak clearly and slowly
• Return all calls within 24 hours
• Never eat, drink or chew gum while talking
• Always begin a call by introducing yourself, your
  company and with whom you wish to speak
• When answering a call immediately write down the
  callers name and repeat it during the
  conversation

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Conclusions

• Violence and hostility is on increase in our day
  to day life. It has become part and parcel of our
  mechanized and competitive world. Nurses are
  round the clock with patients hence they are the
  first one to face the wrath of patients and
  relatives when some untoward incident occurs
  during the care.

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• Dr. Mona Mason, President (Emergency Nurses
  Association) USA says according to a survey by
  ENA in 2006, 86 of emergency Nurses reported
  that they had been victim of violence on job.
• In California assault is punishable for a fine
  not exceeding one thousand Dollars or by
  imprisonment in the country jail not exceeding
  six month.

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• When physical violence is committed to a person,
  it is punishable for a fine not exceeding two
  thousand Dollar or imprisonment not more then one
  year or both fine and imprisonment.
• OSHA (Occupational Safety and Health
  Administration) requires employees to keep record
  of all job related illness accidents. eg.
  Myocardial infarction, Musculoskeletal injuries,
  hearing lost. OSHA gives guideline standards
  regarding safety health full working condition.

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• THANK YOU
• FOR
• YOUR ATTENTION PARTICIPATION