WORKPLACE VIOLENCE AGAINST NURSING
PERSONNEL
A Literature Review
Tuuli Luoto-Korhola
Susanna Niskanen
Bachelor’s Thesis
September 2012
Degree Programme in Nursing
School of Health and Social Studies
Author(s) Type of publication Date
LAST, First Bachelor´s Thesis 28.09.2012
LUOTO-KORHOLA, Tuuli
NISKANEN, Niina Susanna Pages Language
41 English
Confidential Permission for web
publication
( ) Until (X)
Title
WORKPLACE VIOLENCE AGAINS NURSING PERSONNEL
Degree Programme
Degree Programme in Nursing
Tutor(s)
JAKOBSSON, Maarit YABAL, Anneli
Abstract
The purpose of this study was to explore how many nurses, or what percentage of nurses,
have experienced workplace violence perpetrated by patients or visitors, and what type of
violence is directed at nursing staff working in medical hospitals in different countries.
Another purpose was to explore the nature of debriefing and support received by nurses who
had been victims of workplace violence. The aim was for the results to provide useful
information on workplace violence experienced by nurses and contribute to evidence-based
practice. The results of the review could be utilized by nursing students, registered nurses,
licensed practical nurses and management working in the healthcare field.
Electronic search produced eighteen scientific articles, with information from five different
countries that were selected for the review. The statistical data from the different studies had
variations, but most supported the facts that relatively large portion of nurses encounter
workplace violence and that verbal violence, in its’ many forms, is the most common type of
violence encountered. Physical violence experienced can range from physical threats to
rape and assaults with deadly weapons. Weapons most commonly used are hospital
equipment, medical equipment and furniture.
The findings concerning support received by nurses after a violent incident showed that peer
support was, in many cases, the only support received. The nurses feel unsupported by the
management and in some cases, are even afraid of the management reaction to a violent
incident. This fear keeps nurses from reporting the incidents and from getting the needed
help to deal with the consequences.
The issue of under-reporting affects all aspects of studies done on workplace violence in
healthcare. Clear reporting instructions and standard definitions of violence will help to
produce more accurate reports on the phenomena. To reduce the harmful consequences of
workplace violence, nursing staff needs to become aware of their rights to defend
themselves and the right to receive proper support after a violent incident.
Keywords
Workplace violence, assault, support, de-briefing, nursing, hospital, literature review
Tekijä(t) Julkaisun laji Päivämäärä
Opinnäytetyö 28.09.2012
LUOTO-KORHOLA, Tuuli
NISKANEN, Niina Susanna Sivumäärä Julkaisun kieli
41 Englanti
Luottamuksellisuus Verkkojulkaisulupa
myönnetty
() saakka (X)
Työn nimi
WORKPLACE VIOLENCE AGAINST NURSING PERSONNEL
Koulutusohjelma
Degree Programme in Nursing
Työn ohjaaja(t)
JAKOBSSON, Maarit YABAL, Anneli
Tiivistelmä
Tämän opinnäytetyön tarkoitus oli selvittää kuinka moni sairaanhoitaja on kohdannut
työpaikkaväkivaltaa potilaiden tai potilaiden perheenjäsenien taholta. Tämän lisäksi
selvitettiin minkälaista väkivaltaa hoitajiin kohdistuu ja minkälaista tukea hoitajat saavat
väkivaltakokemusten jälkeen. Työssä keskityttiin työpaikkaväkivaltaan, mikä on ongelma
sairaaloissa eri puolella maailmaa. Katsauksen luonteen vuoksi mielenterveyslaitokset
poissuljettiin. Opinnäyte työ toteutettiin kirjallisuuskatsauksena. Tavoitteena oli tehdä
katsaus jossa olisi tämänhetkistä tietoa hoitajiin kohdistuvan työpaikkaväkivallan
yleisyydestä ja luonteesta, sekä heidän saamastaan tuesta. Katsaukseen kerättyä tietoa
voidaan hyödyntää näyttöön perustuvassa hoitotyössä.
Elektroninen tiedonhaku tuotti kahdeksantoista tieteellistä artikkelia viidestä eri maasta.
Tilastollisissa tiedoissa oli eriävyyksiä, mutta kaikista tutkimuksista kävi ilmi, että suuri osa
hoitajista kohtaa työpaikkaväkivaltaa. Verbaalinen väkivalta on tyypillisin väkivallan muoto.
Hoitajiin kohdistuva fyysinen väkivalta pitää sisällään kaikkea fyysisestä uhkailusta aina
raiskaukseen ja aseelliseen pahoinpitelyyn. Yleisimmin käytetyt aseet ovat sairaalan
välineet ja huonekalut.
Lähteiden mukaan vertaistuki on monissa tapauksissa ainoa tuki mitä hoitajat saavat
väkivaltatilanteen jälkeen. Hoitajat eivät koe saavansa tukea esimiehiltään. Joissain
tapauksissa esimiesten suhtautuminen väkivaltatapauksiin aiheuttaa pelkoa hoitajissa, mikä
on syynä tapausten raportoimatta jättämiseen.
Väkivaltatapausten vähäinen raportointi vaikuttaa kaikkiin aiheesta tehtyihin tutkimuksiin.
Selkeä raportointiohjeistus ja selkeät määritelmät siitä mitä työpaikkaväkivallan käsite pitää
sisällään auttaisi tuottamaan tarkempaa tutkimustietoa aiheesta. Hoitohenkilönkunta tietoon
tulisi saattaa heidän oikeutensa puolustautua väkivaltaa vastaan. Heidän on myös
tiedostettava oikeutensa saada oikeanlaista tukea väkivaltatilanteen jälkeen.
Avainsanat (asiasanat)
Työpaikkaväkivalta, pahoinpitely, kriisiapu, hoitotyö, sairaala, kirjallisuuskatsaus,
workplace violence, assault, support, de-briefing, nursing, hospital, literature review
1
Contents
1 INTRODUCTION 3
2 VIOLENT BEHAVIOR AND WORKPLACE VIOLENCE 4
2.1 Legal aspects of workplace violence 5
2.2 Workplace violence in healthcare 6
2.3 Cost of workplace violence 7
2.4 Nurses as targets of violence 8
2.5 Support 9
2.5.1 Psychological first aid 9
2.5.2 Defusing 10
2.5.3 Debriefing 10
3 PURPOSE, AIM AND RESEARCH QUESTIONS 11
4 CONDUCTING THE LITERATURE REVIEW 12
4.1 Principles of literature review 12
4.2 Literature search 13
4.3 Article selection 14
4.4 Analysis and synthesis 18
5 RESULTS 18
5.1 Workplace violence experienced by nurses 19
5.1.1 Violent incidents in general 20
5.1.2 Verbal- and emotional abuse and verbal threats 21
5.1.3 Physical assaults and physical threats 23
2
5.1.4 Assaults and threats with weapons 24
5.1.5 Other types of workplace violence reported 25
5.2 Support after a violent encounter 26
5.2.1 Reporting 26
5.2.2 Managerial support 27
5.2.3 Peer support 29
6 DISCUSSION 29
6.1 Reliability of the review 31
6.2 Conclusions 32
REFERENCES 34
APPENDICES 39
Appendix 1: Table of articles included in the review 39
TABLES
Table 1: Inclusion and exclusion criteria for articles 14
FIGURES
Figure 1: The process of literature search and article selection 17
3
1 Introduction
Working in the social- and healthcare fields increases the persons’ chances of
becoming a victim of violence or aggression (Lehestö, Koivunen, & Jaakkola
2004, 86). The British Crime Survey states that nurses have 5% risk of being
physically assaulted at work. This number is 4 times higher than national
average. (Badger & Mullan 2003). According to the United States Bureau of
Labor Statistics, 60% of all workplace assaults occurred in health care and
most of these assaults were perpetrated by patients (Gates, Gillespie, &
Succop 2011). Despite these figures violent incidents are not always taken
seriously and quite often these incidents are not report to the police or further
investigated (Sajama 2012). Workplace violence can impact the healthcare
field in many ways. The violent situations or dealing with threatening persons
can be very stressful for the professional. (Lehestö et.al. 2006, 86-89). The
monetary cost of one single assault on a registered nurse, according to one
study, is $31 643 (Gates et.al. 2011). Furthermore the nursing shortage is
expected to increase in the future. The recruitment and retention of qualified
staff could be deterred by workplace violence. (Howerton Child & Mentes
2010).
The choice of the theses’ topic was, in part, influenced by the authors’ own
experiences of dealing with aggressive and threatening patients, witnessing
incidents of workplace violence and seeing how these incidents were reported
and how the aftermath was handled. These experiences made the authors
curious as to how many nurses experience workplace violence, the nature of
this violence, and do the nurses receive support after violent incidents.
The aim was for the results to provide useful information on workplace
violence experienced by nurses and contribute to evidence-based practice.
The results of the review could be utilized by nursing students, registered
nurses, licensed practical nurses and management working in the healthcare
field.
