Patients ’ violence towards nurses : A questionnaire survey

G. Balamurugan © 2012 International Journal of Nursing This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited G. Balamurugan et al. | Patients’ violence towards nurses: A questionnaire survey International Journal of Nursing 1(1), 2012 2 Introduction and Significance India is one of the largest demographic countries in the world with the second largest population. Last ten years the economic growth of the nation is highly increasing than ever before. Health care is one of the fields growing along with the country‟s overall growth. In 2010, India will be world‟s largest mass health care provider. To meet the demand, India produces largest number of nurses in the world. Violence in all its forms has increased dramatically worldwide in recent decades. Now concerns are wide spread over workplace violence against health workers. The problem of violence in health care is not new; it has probably always been a part of nursing (Paterson M, 1999). Violence has been defined as any aggressive behaviour “aimed at inflicting harm or discomfort on its victims” (Felton, 1997). Verbal abuse is a form of workplace violence that leaves no visible scars; however, the emotional damage to the inner core of the victim‟s self can be devastating (OSHA, 2004). ICN report paper said that ninety five percent of nurses around the world are women. Attitudes towards women are reflected in interactions with the profession. A study showed that health care workers are more likely to be attacked at work than prison guards or police officers, nurses are the health care workers most at risk, with female nurses considered the most vulnerable, general patient rooms have replaced psychiatric units at the second most frequent area for assaults, physical assault is almost exclusively perpetrated by patients, 72% of nurses don‟t feel safe from assault in their workplaces, up to 95% of nurses reported having been bullied at work, up to 75% of nurses reported having been subjected to sexual harassment at work. The continuous exposure to violence led many mental health nurses in the UK to accept it as a normal part of their work and they failed to demand better measures to protect them (Martin 1984). Altshul and Booking (1981) also warned of the deleterious effects of poorly trained staff and uncoordinated treatment interventions. Brennan (1997) found that 57% of nurses have been assaulted in last 2 years and 93% were verbally abused. Verbal abuse from the physicians and patients accounts for the highest incidents of aggression towards nurses in health-care settings (Copper, 1996). Research has shown those nurses‟ experience high rates of verbal abuse, from 82% to 97% (Cameron, 1998 and Fernandes et al, 1999). Verbal abuse significantly impacts the workplace by decreasing moral, increasing job dissatisfaction, and creating a hostile work climate (Aiken et al, 2001 and Manderino et al, 1997). Furthermore, verbal abuse negates a caring organizational culture and threatens the organization itself by higher turnover rates, increase lawsuits, decrease productivity, increased errors, and overall decreased quality of care (Cox, 1987 and Bush,H & Gilliland, M. 1995). Failures to address verbal abuse places hospitals at risk to increased turnover and cost resulting from decreased productivity and job satisfaction(Aiken et al, 2001 and Nield-Anderson L, & Clarke J,T, 1996). Thus, this study was designed to describe the frequency and severity of verbal and physical violence towards nurses from patients, working in hospitals in India Review of Literature The review of literature of the present study consists of studies related to violence against nurses from various countries. Ryan, P.E. , Hart, V.S. , Messick, D.L. Aarom, J., & Burnette, M. (2004) conducted a prospective study on assault against staff by youths in a state psychiatric hospital for children and adolescents to examine the frequency and nature of violence directed at staff. The study sample comprised all 111 patients who were hospitalized during the study period (December 3, 2001, to February 3, 2002) and 140 employees who had patient contact, including direct care staff, clinicians, and teachers (140 individuals). All staff who were involved in the direct care of patients were asked to complete a confidential questionnaire immediately after the assault. Of the 111 participants, the 37 (33 percent) who committed assaults during the course of the study were deemed to be assaultive. Most incidents (116 incidents, or 54 percent) against staff resulted in no detectable physical injury. However 99 incidents (46 percent) produced level 2 or 3 injuries: six assaultive incidents (3 percent) resulted in injuries that required medical attention. The results of this study indicate that physical assault against staff in child and adolescent psychiatric settings is frequent and problematic. Winstanley,S. , & Whittington,R. (2004) conducted a study on “Aggression towards health care staff in a UK general hospital: variation among professions and departments”. This study extends existing research by evaluating physical assault, threatening behaviour and verbal aggression from patients/visitors towards general hospital staff in the context of different professions and departments. Results showed that aggression is widespread. Within the preceding year, 27% of the respondents were assaulted, 23% experienced threatening behaviour from patients and 15.5% experienced threatening behaviour from visitors. Over 68% reported verbal aggression, 25.7% experiencing it more regularly than monthly. G. Balamurugan et al. | Patients’ violence towards nurses: A questionnaire survey International Journal of Nursing 1(1), 2012 3 Staff nurses and enrolled nurses reported the most assaults (43.4%) and doctors, the fewest (13.8%). Other nursing grades and health care professions all reported levels of physical assault in excess of 20%. Lin, Y. , & Liu. (2005), conducted a study on “the impact of workplace violence on nurses in south Taiwan”. The purpose of this study was to explore the prevalence of workplace violence (WPV) committed by patients and their family members against healthcare workers in south Taiwan. Two hundred and thirty nurses in a 400 bed hospital were sent surveys. Response rate was 94.8% (205). The Chinese workplace violence incident questionnaire with 32 items was designed by the researcher. The instrument was distributed to nurses by their head nurses. Completed questionnaire were returned within one week to the appropriate head nurse. Nearly two third of the nurses reported experiencing a WPV event (n = 127; 62%). A majority of the nurses representing a variety of clinical settings in nursing, reported experiencing WPV, including verbal (n = 111, 53.9%) and physical (n = 61; 29.6%). Many nurses reported experiencing more than one WPV event (n = 81; 39.3%). However, the experience of WPV significantly differed depending on the subject‟s education (χ2 = 2227.95; p = 0.00), Years of nursing practice at the time of WPV events (t = 0.68, p =0.49), age (t = -0.75, p =0.87), and training against violence (χ2 = 0.05; p = 0.82) were not found to be associated with WPV. Experience of WPV among nurses in Taiwan was common especially the verbal type and all settings were potentially high risk. However the present study is unique in terms of population selected i.e. registered nurses working in hospitals in India and the study planned to explore the occurrence of violence in India. Method The purpose of the study The purpose of this study is to determine the nature and extent of violence experienced by nurses working in hospitals, from patients. This will help the nurses to understand the sufferings they are tolerating at work and will prompt the nurses to take necessary actions to prevent and manage violence. The objectives of this study were to  determine the occurrence of violence towards nurses.  compare the physical and verbal violence towards nurses.  find the association between the violence and selected variables. 3.1. Design A descriptive survey design was used for the study, with verbal and physical violence as dependent variables. The independent variables were the demographic variables such as age, gender, religion, marital status, professional qualification, designation, years of experience in present area, and total years of experience. 3.2. Sample size and method A purposive sampling was used to select the sample from Mental health hospital (A) located in Bangalore, Karnataka, India. Two hundred and fifty questionnaire were distributed to the nurses through ward in-charges on April 2006. At the end of data collection period i.e. May 2006 the researcher got back 179 filled usable questionnaire with the response rate of 71.6%.