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The Experiences of Psychiatric Nurses Who Are Exposed to Workplace Violence

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Violence against health workers represents approximately a quarter of total work violent events. These situations, therefore, have been observed, or else are routine for some nursing professionals. Analysis of violence suffered by nurses who worked in the emergency room, intensive care unit, and in Psychiatry units in Turkey has identified that most nurses (60.8%) have been exposed to verbal and/or physical violence from patients, visitors or health workers.

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While working as a newly recruited registered nurse (RN) in the short stay unit at our local hospital I was providing care for a 25 years old woman. She was 13 weeks pregnant and a missed abortion. The patient was in the process of passing products of conception, experiencing a severe pain, constantly screaming and demanding me to provide her with much stronger pain medication. I have explained that I have already administered painkillers, as prescribed, and it would take time for them to kick in

Yet, patient was not listening and continuously demanded to see the physician. After numerous unsuccessful attempts, I contacted the physician, explained the situation and was immediately yelled at, instantly being labeled as “unworthy, not knowing anything, unable to do my job” with many other degrading and demeaning remarks at each phone call. Shocked, I contacted my supervisor and asked for an advice, but got the reply that “these things happen… welcome to the real RN life, calm down and try to contact him again”. I have never encountered these kind of physician-nurse relationships before. The situation of the workplace violence speaks to me directly as it affects not only my personal wellbeing, but also impacts the quality of care I provide. Unsafe workplace environment allowing for re-occurring violence outbreaks in any form ultimately leads to deteriorating outcomes in emotional and mental health of the nurse, personal well-being and patient safety.

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Registered nurses (RNs), compared to other healthcare providers are at a higher risk of experiencing violence in the workplace that is initiated by patients and families]

Between 25 and 80 % of nurses working in acute care hospitals have reported experiencing patient violence in one form or another [Nolan P, Dallender J, 1999] with existing literature hypothesizing that these events are vastly underreported [3, 7, 8]. In Canada, it has been reported that almost one third (29 %) of nurses working in direct care hospitals or long term care facilities reported a physical assault by a patient in the last 12 months, and 44 % reported having experienced emotional abuse. Specifically within the psychiatric nursing population, Hesketh and colleagues [Nolan P, Dallender J, 1999] reported that 55 % of Canadian psychiatric nurses were victims of verbal or emotional abuse, 19.5 % experienced sexual abuse, and 20.3 % reported physical abuse in their last five shifts. Psychiatric nurses report among the highest violence victimization rates of all types of nurses [Arnetz J, Hamblin L, 2014]. The short or long-term exposure to any type of violence can result in negative outcomes for nurses and organizations. For nurses, there may be both physical and psychological consequences.

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Ordinarily, Classification Tree is a recent tool for assessing the violence risk of patients discharged from psychiatric facilities. This tool utilizes a sequence of questions related to risk factors for potential violence. According to the answers, another related question is posed, until the pt is classified into a category of high or low risk of future violence. Structured risk assessment tools have inherent limitation when used alone. Criticisms of instruments include the following: they provide only approximations of risks; their use is not generalizable beyond the studied populations: they are rigid, and they fail to inform violence prevention & risk management.

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Arnetz J, Hamblin L, Essenmacher L, Upfal M, Ager J, Luborsky, M. Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. J Adv Nurs. 2014.

Nolan P, Dallender J, Soares J, Thomsen S, Arnetz B. Violence in mental health care: the experiences of mental health nurses and psychiatrists. J Adv Nurs. 1999

Hesketh K, Duncan S, Estabrooks C, Reimer M, Giovannetti P, Hyndman K, et al. Workplace violence in Alberta and British Columbia hospitals. Health Policy. 2003;63:311–21.

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