Strategies to Prevent Lateral Violence in Nursing
STRATEGIES TO PREVENT LATERAL VIOLENCE IN NURSING 9
Strategiesto Prevent Lateral Violence in Nursing
Strategiesto Prevent Lateral Violence in Nursing
Problemor Knowledge Focused Triggers
Thereis a high prevalence of lateral violence and other forms of abuse inthe healthcare environment, and this threatens the quality ofhealthcare delivery. Lateral violence or horizontal violence denotesany form of aggression perpetrated among practitioners in the nursingprofession. Commonly, new nurses and nursing students are the primaryvictims of lateral violence, and it takes the form of fault-finding,unfairness in assigning duties, refusal to offer assistance,criticism, ignoring, shouting, and undermining among others. Surveydata indicates that the persistence of lateral violence stands at anestimated rate of 65 to 80 percent(Becher & Visovsky, 2012).The figure might be higher bearing the fact that in most casesincidences of lateral go undetected or noticed. Lateral violence hasdetrimental effects in the working environment, affecting the nursingteam, and extends to patient care. At an individual level, thebehavior results in depression and the high number of turnovers amonggraduate nurses. Absenteeism and turnovers have a financial strain tohealthcare institutions, which spend significant resources intraining and assimilation of graduate nurses. In this backdrop, thereis an urgent need to develop strategies aimed at reducing the impactsof lateral violence in the workplace environment.
Variousscholars have delved into the subject of lateral violence,highlighting its pervasiveness, effects, and possible remedy.According to Blair(2013), horizontal violence is an act of bullying or incivility inthe working environment. He highlights that at least one practitioneramong six practitioners in the health care environment has been avictim of horizontal violence. Similarly, he documents that researchconducted by other scholars in the industry estimates that theprevalence of horizontal violence in different health-careinstitutions varies in the range of between 46 to 100 percent.Evidently, the occurrence is a clear manifestation of the existenceof horizontal violence in the industry, and it is a wake-up call toall stakeholders in the industry.
Furthermore,Blair (2013) categorizes lateral violence under three forms, whichinclude psychological, physical, and verbal. Verbal unbecomingbehavior is more common and entails verbal attacks, offensivecomments, and the use of demeaning language. Physical violence takesthe form of unwelcome sexual advancement. In particular, it is onlyunder sexual harrasment that there are laws for possible prosecutionof offenders. Psychological violence entails uncooperation, heapingblame on an individual in the event of an error, unwarranted attackson an individual’s character, and withholding critical informationfrom others. Psychological violence is often covert, an aspect thatmakes it hard for the management to detect or address.
Inthe same vein, Blair (2013) goes on to say that, horizontal violencehas adverse effects on nurses and victims experience depression,feelings of guilt, substance abuse, and at extreme cases suicidaltendencies. However, he notes that nurses working in emergencydepartments tend to defend their behavior on the grounds of workdemands and fatigue. Noteworthy, lateral violence attributes to amajority of the occurrence of sentinel events.
Similarly,Myers,et al. (2016) conducted research to gather information on theexperience of nurses regarding lateral violence in three differenthealth care institutions in the United States. The study narrowed itsfocused to a single city and interviewed 126 nurses. The nursesresponded by giving a description of the character, setting, andeffects of workplace bullying incidences. From the responses, theresearch established that the nurses had a consistent experienceregardless of the organizational structures of their respectivehealth care institutions. Horizontal violence was more of an inherentculture in the nursing landscape. Of importance, the nurses expressedan immense desire for change in their workplaces and even enquiredfor solutions to remedy the pervasiveness of workplace bullying.Besides, the study concluded that nurse managers have to consistentlyseek to address the menace and adopt new interventions to change theexisting culture.
Inthe same manner, Francesca & Charlotte (2015) conducted a surveyto determine the association between workplace incivility and theintention to leave. The survey targeted 300 registered nurses from ahealth care institution in Midwestern and used questionnaires tocollect data. Upon the completion of data collection, the teamperformed various descriptive and statistical measures. The findingsindicated that nurses of all ages and experience had been victims oflateral violence. In particular, the forms of violence included theimposition of other person’s responsibilities, confrontations inthe presence of co-workers, lack of acknowledgment, andmisinformation of being exchanged. Similarly, the findings indicateda strong correlation between pervasiveness of workplace bullying andthe intent to leave. As such, young nurses were more likely to leavethan the old and experienced nurses. The study concluded saying thereis an urgent need to address the perception of lateral violence inthe nursing profession. Recommended interventions entailed mentoring,continuous assessment of organizational culture and nontolerance ofworkplace bullying.
Lateralviolence is a complex problem, and its resolution will take amultifaceted approach. This approach entails awareness creationthrough professional workshops, training nurses and nursing studentcognitive rehearsal, and non tolerance on incidences of lateralviolence. Awareness creation is the first step towards addressingincivility in the nursing profession. On a regular basis, healthcareinstitutions should organize workshops where nurses and studentsassemble and share their experiences with lateral violence. Sharingserves to encourage victims to speak up and aids nursing managers toaddress specific incidences of bullying in their respectiveworkplaces. Besides, effective communication among nurses is a keyelement in curtailing workplace bullying (Khadjehturian, 2012).
Second,training of both practicing nurses and nursing students on cognitiverehearsal skills will play a vital role in fostering the ability andconfidence to deal with incidences of horizontal violence. Fear is amajor downside of addressing lateral violence and victims have toovercome it. Cognitive rehearsal is a term that describes a method toregulate emotions using cognitive skills by downplaying the emotionalimpact of a stressful incidence (Wilkins, 2014). Cognitive rehearsaltraining focuses on equipping individuals with knowledge of the bestcodes of conduct, individual perception and recognition of horizontalviolence, management of reactions, rehearsal on how to respond in asafe and cooperative platform, and heightening confidence levels. Thebasic essence of training nurses on cognitive rehearsal is to promotetheir confidence and ability to manage and confront incidences ofworkplace incivility. Besides, it will also create consciousnessamong practitioners in nursing to evaluate their behavior todetermine if its effects on co-workers amount to bullying (Florriann& Michelle, 2016).
Similarly,the nursing profession as a whole has to establish measures fosteringnontolerance of workplace incivility. The nursing council has to comeup with policies stipulating the code of conduct of nurses in theworkplace and specific disciplinary actions for those found engagingin horizontal violence. Part of the prevalence in workplaceincivility attributes to the lack of laws to regulate the behavior.However, having laws to address the behavior will encourage victimsto report cases of bullying, which will ultimately aid nursingmanagers to take corrective measures.
Theeffectiveness of implementing the strategies will determine itssuccess. As such, the implementation process will focus on twogroups, nursing students and nurses in practice. The first phase willrequire the collection of data regarding the types of lateralviolence experienced in nursing practice. This data will beinstrumental in establishing a cognitive rehearsal program that iscontext specific. The second phase of implementation will target totrain nursing students in their final year of schooling. Besides, itwill also involve practicing nurses on cognitive rehearsal skills.Similarly, the training program will also train the participants onthe importance of communication to promote healthy relations in thenursing profession. Finally, the implementation process willculminate by organizing a stakeholders meeting to set up regulationsand disciplinary measures to address workplace incivility.
Monitorand Analyze Outcome of Data
Themonitoring process will consider various elements of the bullyingintervention strategies. There will be a control group of youngnurses who have never received training skills on cognitive rehearsaland a random sample of nurses from different hospitals who haveundergone the cognitive rehearsal training. A random sample of thecontrol group will have to fill a questionnaire regarding theirexperiences with lateral violence. In particular, the questionnairewill seek to find responses on job satisfaction, intent to leave,stress, management of workplace bullying, and sentinel incidences.Using the method that Griffin & Clark (2014) used to collect datain their intervention, a sample of young nurses having receivedtraining on cognitive rehearsal skills will fill the samequestionnaire as the control group. The data collected will then seekto find the relationship between cognitive rehearsal skills andreduction of the prevalence of workplace incivility among nurseshaving undergone the program.
Evaluationof the survey data will be both qualitative and quantitative.Participants in the sample survey will be asked on their levels ofjob satisfaction, work relations, and intent to leave, and theirmanagement of stressful situations. Besides, nursing managers in thehospitals where the sample population will be asked to rate theperformance of nurses with cognitive skills. On dissemination, thisstrategy proposal will function as a pilot project in theinterventions to end workplace incivility in the nursing profession.The findings of the evaluation process will be disseminated to otherhealth care facilities and nursing schools. Furthermore, thedissemination process will involve the presentation of the findingsat conferences and through the publishing of articles inpeer-reviewed journals.
Certainly,lateral violence is widespread in the nursing profession, and itposes a significant threat to professional development and thedelivery of patient care. The behavior is the primary course of lowjob satisfaction, attrition, and sentinel events. In this backdrop,there is need to address the problem. Strategies to address thepervasiveness of workplace bullying in nursing include awarenesscreation through professional workshops, training on cognitivereappraisal skills, and nontolerance of the behavior. Thesestrategies foster the development of confidence and behavioralmethods to manage incidences of bullying.
Becher,J., & Visovsky, C. (2012). Horizontal Violence in Nursing.MEDSURGNursing, 21(4), 210-214.
Blair,P. L. (2013). Lateral Violence in Nursing. Journalof Emergency Nursing, 39(5), 75-78.
Florriann,F. C., & Michelle, S. L. (2016). Cognitive Rehearsal Training forUpskilling Undergraduate Nursing Students Against Bullying: AQualitative Pilot Study. QualityAdvancement in Nursing Education,2(1).
Francesca,A., & Charlotte, B. (2015). Perceptions of horizontal violence instaff nurses and intent to leave. Work,51(1), 91-97.
Griffin,M., & Clark, C. M. (2014). Revisiting Cognitive Rehearsal as anIntervention Against Incivility and Lateral Violence in Nursing: 10Years Later. TheJournal of Continuing Education in Nursing, 45(12), 535-542.
Khadjehturian,R. E. (2012). Stopping the Culture of Workplace Incivility inNursing. ClinicalJournal of Oncology Nursing, 16(6), 638-639.
Myers,G., Côté-Arsenault, D., Worral, P., Rolland, R., Deppoliti, D.,Duxbury, E., et al. (2016). A cross-hospital exploration of nurses`experiences with horizontal violence. Journalof Nursing Management, 24(5), 624-633.
Wilkins,J. (2014). The use of Cognitive Reappraisal and Humour as CopingStrategies for Bullied Nurses. InternationalJournal of Nursing Practice, 20,283-292.
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