Change Framework to Lateral Violence in Nursing Practice

Lateral violence includes all acts of intimidation, humiliation bullying, unwarranted criticism and angry outbursts among other forms from a worker directed to another working (Clarke, 2014). In my current practice, most experienced nurses often feel superior to their inexperienced junior nurses. Therefore, they treat them with contempt as they feel they are more knowledgeable than them. For instance, one nurse may respond with an outburst on anyone enquiring of something that a colleague may have already have explained or considered it a too obvious. In some instances, one nurse may be disrespectful to others and refuse to engage another nurse in sharing patient information or other information that is pertinent to the nursing practice. If no one is willing to talk about and to address lateral violence, it will become a culture in nursing practice that will hinder teamwork and information sharing thereby hampering the overall quality of service.

There are several reasons why lateral violence must change particularly in the nursing practice. Firstly, all healthcare systems aim at creating an environment that enables safe healthcare provision. The provision of this safe healthcare largely relies on cooperation and communication between healthcare givers. However, Lateral violence hinders the effectiveness of this communication and hence acts as an impediment to the provision of safe healthcare (Clarke, 2014). Therefore, lateral violence must change to create an environment enabling the provision of safe healthcare.

Secondly, lateral violence affects the productivity of individual nurses and their ability to deliver on their responsibility. An atmosphere of intimidation leads nurses to feel incapacitated in the delivery of healthcare. It robs the nurses the confidence of their capabilities and hence reduces their motivation in providing quality healthcare. For instance, a nurse who is constantly intimidated or harassed in different ways will not be able to freely provide care since he fails confident of his or her ability to provide such care. Therefore, Lateral violence must be eliminated in order give all nurses the support that gives them confidence in providing quality healthcare.

Thirdly, Lateral violence hinders information sharing in the nursing practice. For instance, a nurse may be less willing to share information he or she knows about a particular patient with another nurse because of fear of prejudice. Consequently, the nurse may not give adequate and quality healthcare to the patient because he or she does not know the essential information that may support the process depending on the circumstances of the patient. Therefore, lateral violence must change to encourage the efficient flow of information from one caregiver to another.

The reasons discussed above among others indicate the extent to which lateral violence affects the provision of safe and quality healthcare. It is reasonable to conclude that lateral violence in the setting of the nursing practice hinders the provision of safe and quality healthcare. Therefore, the change of this culture is necessary to guarantee an environment that supports safe and quality healthcare.

Several stakeholders in the nursing practice are affected by the existence of lateral violence in the healthcare settings. These stakeholders include the healthcare facility management, patients, government, physicians and the nurses themselves among others. The stakeholders play a role in eliminating lateral violence in the workplace and particularly in healthcare settings. Therefore, these stakeholders must play an active role in eliminating lateral violence in healthcare facilities.

Firstly, the management of any healthcare facility or organization has the primary role in shaping the culture of the organization or healthcare facilities. They do this by outlining policies and procedures on different matters of interest to their facilities or organizations as well as the overall practice of healthcare provision. Therefore, the management of such facilities and organizations must equally foster an organizational culture of tolerance and condemn any act of lateral violence. The management can achieve this in two three ways. First, the management should outline a policy against lateral violence in their healthcare organizations. The strategy will foster a culture of mutual respect and tolerance and hence eliminate lateral violence. Secondly, the management should outline strict disciplinary consequences for acts of lateral violence. Lastly, the management must carry out an extensive awareness campaign among its staff and nurses in particular on the effect of lateral violence on quality healthcare.

Secondly, patients must equally be involved in stopping the practice of lateral violence in the healthcare setting. The patients must not entertain any healthcare giver or nurse who openly intimidates his or her college in their presence. Patients must learn to speak out on behalf of their patients who constantly suffer prejudice and intimidations in their presence. The patients should condemn any nurse who propagates lateral violence and informs them of the effect of such violence on the overall healthcare system.

The government is an equal interested party in healthcare provision that must equally play a role in changing the culture of lateral violence. The government regulates health care services and hence must use such regulatory authority to change the culture of lateral violence in healthcare facilities. For instance, the government can institute policies and laws that monitor and give strict consequences to lateral violence in healthcare facilities. This regulation and enforcement will help greatly in changing the culture of lateral violence in healthcare facilities.

Lastly, nurses must themselves play a critical role in changing the culture of lateral violence in healthcare facilities. The nurses should sensitize their fellow nurses on the impact of lateral violence on the entire healthcare system. This understanding will greatly help in creating awareness on the far-reaching effect of lateral violence on the entire healthcare system and hence stop it. Moreover, this peer approach will help to keep each other in check regarding lateral violence and hence create an atmosphere that supports tolerance among nurses.
Evidence Critic Table
Evidence
Evidence strength (1-7) and evidence hierarchy

Pontus, C., & Ortner, P. (2013). The Relationship between Lateral and Horizontal Violence and Bullying. Epidemic of Medical Errors and Hospital-Acquired Infections, 2(2), 209-224
Evidence strength is 2
The article presents a case study showing how bullying, Horizontal and lateral violence interacts. The authors of the article carry out a research study that seeks to demonstrate that interrelationship. This article contributes to the topic of lateral violence by demonstrating how deferent stakeholders foster lateral violence and how they can be involved in changing the culture.

Sanner-Stiehr, E. (2017). Using Simulation to Teach Responses to Lateral Violence. Nurse Educator, 42(3), 133-137.
Evidence strength 6
The article illustrates how simulation can be an effective tool in teaching nurses on the impact of lateral violence and hence contributing to the overall change of the culture of lateral violence in the setting of healthcare facilities. This article contributes to the topic of lateral violence by explaining how the administrations of healthcare facilities can effectively use training as a way of sensitizing about the overall effect of lateral violence to the healthcare system.

Sanner-Stiehr, E., & Ward-Smith, P. (2014). Lateral violence and the exit strategy. Nursing Management (Springhouse), 45(3), 11-15.
Evidence strength 5
This article defines lateral violence and outlines its effect on the healthcare system. The article also discusses how various stakeholders contribute to the existence of lateral violence and how they can equally play a role in eliminating such violence. Overall, the article highlights the various ways through which the healthcare facility can effectively create an atmosphere of tolerance and change the culture of lateral violence. This article is relevant to the current topic as it highlights strategies of exiting from the culture of lateral violence.

Dahlby M.A., Herrick L. M., (2014) Evaluating an Educational Intervention on Lateral Violence. The Journal of Continuing Education in Nursing, 45(8), 351-352.
Evidence rating 1
This article evaluates the effectiveness of the educational intervention in eliminating lateral interventions in a healthcare setting. The research presented in this article was conducted through a pre-education evaluation test and a post-education evaluation test on the attitude of nurses towards lateral violence. 29 nurses were sampled for this exercise. The findings of this research indicate that educational interventions help reduce or eliminate the extent of lateral violence in the setting of healthcare. This article is relevant to the topic as it gives practical experimental evidence on the effect of educational interventions on the extent of lateral violence in healthcare facilities.

Ceravolo, D. J., Schwartz, D. G., Foltz-Ramos, K. M., & Castner, J. (2013). Strengthening communication to overcome lateral violence. Journal of Nursing Management, 20(5), 599-606.
Evidence rating 1
This article describes how the strategy of strengthening communication among nurses can effectively help in eliminating lateral violence. The article presents a research study in which nurses were taken through a communicational strengthening educational program and subjected to a pre and post interventions survey. The finding of this research indicates that the reported cases of lateral violence greatly reduced when the nurses were subjected to these interventions. Therefore, the article concludes that strengthening communication among nurses is a strong way of changing the culture of lateral violence in healthcare settings. This article addresses the aspect of communication on changing the culture of lateral violence.

The evidence presented in the table above demonstrates that indeed lateral violence is an impediment to the achievement of quality healthcare and in the creation of a conducive environment in which nurses can operate. Pontus and Ortner, (2013) illustrate that the top management influences the culture in any organization. For instance, the article illustrates that in a health facility where the leadership of the organization supports horizontal violence lateral violence is likely to occur. The article holds that leaders in the healthcare settings who propagate violence on their juniors fuel the growth and development of a culture of lateral violence within the organization. Therefore, the article advices leaders to shun horizontal violence if they are to deal with lateral violence.

A similar view on the role of leadership in ending lateral violence is also held in Sanner-Stiehr & Ward-Smith (2014). The article highlights leadership as a fundamental foundation over which culture is built. According to the article, Leadership plays a critical role in either fostering or eliminating the culture of lateral violence from a healthcare setting. Consequently, a leadership that openly condemns lateral violence will foster an environment of healthcare in which lateral violence is not tolerated. The article further defines the roles of other stakeholders of healthcare systems in the fight against lateral violence. It identifies the healthcare administration, the physicians, the nurses, the patients and the community as critical stakeholders whose efforts in the fight against lateral violence will help in changing such a culture.

The evidence presented in the table further highlights the critical interventions that can be put in place to ensure that the culture of lateral violence is changed. For instance, they identify enhancing communication among healthcare givers as a critical intervention that can significantly contribute to lateral violence in the healthcare setting. The experimental research presented by Dahlby & Herrick, (2014) demonstrate that effective programs that enhance communication among health care givers lead to a great reduction in incidences of lateral violence. Therefore, it is imperative for healthcare facilities and organizations to carry out extensive training programs that foster interactions and communication among health caregivers if they are to deal with the problem of lateral violence effectively. Sanner-Stiehr (2017) further highlights the effective way of teaching interpersonal communication among other aspects of lateral violence to the healthcare givers. Moreover, Ceravolo et al. (2013) emphasize the effectiveness of communication interventions in dealing with the culture of lateral violence. The article presents research that evaluates and proves the effectiveness of communication interventions to lateral violence.

In summary, all the articles presented agree on the fact that lateral violence hinders the effectiveness of delivering quality healthcare in health facilities. They further present evidence of the practicability and effectiveness in some interventions such as communication. The evidence presented in these articles further illustrates the role of each stakeholder in dealing with the problem of lateral violence.

Based on the evidence, the best practice in healthcare settings are effective communication. Communication must be effective both from a horizontal perspective and at lateral level. In horizontal communication, leaders must ensure that they communicate effectively and objectively to the junior nurses. Effective communication is one that is considerate of the recipient’s status in the organization. Therefore, effective horizontal communication does not take for granted the humble beginnings of individual nurses and values their growth and contribution to the overall healthcare system. Notably, the nature of horizontal communication reflects in the lateral communication within the organization. For instance, an abusive and intimidating horizontal communication will ultimately lead to an abusive and intimidating lateral communication (Dimarino, 2011).

Similarly, effective communication must be encouraged at the lateral level. The management of healthcare facilities should invest in communication training and intervention programs that enhance the communication and interactions among caregivers. Moreover, the management must equally lead nurses in demonstrating how and why they should communicate effectively with one another. Lateral communication intervention greatly reduces the cases of lateral violence reported within any healthcare settings. Therefore, communication is the best practice that health caregivers must embrace that will significantly reduce cases of lateral violence within healthcare settings and hence promote an environment that supports information sharing among healthcare givers. Therefore, it will help in fostering quality and safe healthcare in the healthcare systems.

The most appropriate model of transformation that can be effectively used facilitates the change in the culture of lateral violence in healthcare settings is the star model for Knowledge transformation. The evidence-based change model seeks to integrate the proven knowledge on healthcare into clinical practices and procedures.

This model of change will be effective in bringing the desired change in the culture of lateral violence in healthcare settings in different ways. First, the model proposes an integration of the change model into the standard healthcare processes and procedure (Melnyk & Fineout-Overholt, 2011). Therefore, the healthcare givers will be bound both ethically and professionally to strict adherence to the standard processes and procedures. The caregivers will attach a similar weight of importance to the dictates of this change as they do to other processes and procedure in the practice of healthcare. Moreover, the violation of the dictates of this change framework model will attract similar consequences to the violation of any part of the standard processes and procedures. Consequently, health care gives will be obliged adhere strictly to the requirements of this change. Therefore, this change model provides a way through which the change in the culture of lateral violence can be implemented.

Secondly, this model is based on knowledge transformation (Melnyk & Fineout-Overholt, 2011). As already noted from the evidence presented, education is an effective intervention to the problem of lateral violence. This model is centered on the transfer of knowledge to the nurses and other healthcare givers on the impact of lateral violence on the entire healthcare system as well as individual caregivers. Moreover, the change model empowers the nurses with knowledge on how they can contribute to changing the culture of lateral violence in their roles as nurses and the association with each other. Moreover, this change model seeks to empower all stakeholders with knowledge on their roles as well as their collective roles in eliminating the vice.
Lastly, this model is effective because it gives the framework of evaluating its effectiveness in bringing about the change that it intends to. For a change model to be effective, it must give room for the evaluation of its effect on the change in question. This evaluation points out the shortfall in the implementation and execution of the change in question. Through this model, the health care system will be able to monitor the effectiveness of the change and put in place measures for continuous improvement of the system.

This change model can be implemented through a five-stage process. The first stage in this implementation will be the identification of knowledge. It involves identification of the information about the extent of lateral violence in the healthcare systems and the effect on the effectiveness of the healthcare systems in delivering quality and safe healthcare. The second stage of change implementation relates to the gathering of sufficient evidence on the effectiveness of healthcare systems that lack a culture of lateral violence in comparison to the ones that have the culture of lateral violence. The third stage will involve the translation of the evidence collected into the framework of the nursing practice. The last stage will involve the integration of the information and the resultant nursing practice determined by the normal processes and procedures of nursing. Therefore, the five steps outlined will guide the implementation of the change model identified.

Several barriers will influence the success of the change framework once implemented. The first barrier to its implementation is the difficulties of behavior change. Most often, the behavior of people is often embedded in their social identity. Such behaviors in individuals are so deeply rooted and constitute their identities and define them. Therefore, the process of changing this behavior in individuals who are accustomed to them can be slow. The nurses who are deeply rooted in the behavior of lateral violence will find it hard to change their behavior and their overall perception about their colleges and adopt the behavior of tolerance for each other (Dimarino, 2011). This change in behavior is likely to be slow and hence is likely to impact negatively on the pace of change implementation.

The second barrier to effective change outlined in this paper is lack of goodwill and support from the management and leadership in nursing units. For any change to be implemented effectively, it must have the goodwill and support of the leadership. Without the support, the implementation process becomes superficially unsustainable. The management and leadership goodwill is at the core of the change implementation framework as suggested in this study. Without the goodwill of the leadership, the enforcement of nursing processes and procedure that incorporate the change to the culture of lateral violence will not be implemented successfully (Pontus & Ortner, 2013). There is likely to be lack of goodwill from leadership since the leadership is equally involved in horizontal violence. Therefore, they may lack the moral justification to support the implementation of the framework.
Thirdly, the financial implication may equally form a barrier to the successful implementation of the change. In this case, the implementation involves education and training as practical interventions to change both the perception as well as the behavior of nurses about lateral violence. This training and education may require outsourcing of expert trainers and educators in the field of interpersonal relationships and communication. Therefore, the healthcare facilities will incur costs in the course of this training and education. This financial implication of the change process may form a barrier to the implementation of this change process especially in healthcare institutions and organizations that suffer financial constraints.

The fourth barrier relates to the organizational culture of healthcare facilities. The organization culture constitutes of behavior, attitude, values, and actions of members of an organization that characterize the organization itself. The organizational culture takes time to build and is often deeply rooted in the organization. The change of such culture takes time and may not be effected within a short time. A good example of the organizational culture is the culture of lateral violence. Where this culture exists, its possess challenges to efforts of change since it is deeply rooted in the organization. Where the aspect of lateral violence is a characteristic of the organizational culture, it possesses a challenge in changing the people’s perception and introducing a different behavioral aspect.

The last barrier relates to perverse incentives that attract people to act contrary to the requirements of the framework. These are considered as disincentives to acting against lateral violence. Disincentive to change in lateral violence could include lack of strict disciplinary actions taken against those who propagate lateral violence. In such cases, the nurses are dissuaded to strictly adhere to the requirements outlined for change against lateral violence. Moreover, organizations that do not reward outstanding behavior among nurses may negatively promote the bad behaviors. Therefore, perverse incentives may act as barriers to the implementation of the framework.

Several ethical implications arise from the implementation of the framework. Firstly, the change process encourages communication and information sharing. It includes all information that a nurse may have about a particular patient. The ethical dilemma in this implementation is the extent to which privacy of the patient is preserved in the midst of an environment that openly encourages information sharing (Dimarino, 2011). There is information that a patient may share with his or her nurse in confidentiality and may not wish to disclose such information to any other party. However, free communication among caregivers that this model of change encourages information sharing. This creates a situation where the privacy and confidentiality of the patient are violated. With the desire to overcome this ethical challenge, the implementation process must clarify the extent to which information sharing is encouraged in an environment of free and respectful communication. In the end, it will preserve and confidentiality of the patient.

The second ethical challenge in the implementation of this change is the control of individual freedom of expression. People may have opinions about the way a person undertakes a given task or a particular process in general. They are entitled to their opinion and have the moral right to express such opinion. Therefore, suppressing such fundamental right is a violation of the people’s right to freedom of expression thereby unethical. The ethical dilemma in this implementation is to distinguish distinction between the freedom of expression and lateral violence. Therefore, it is important to educate nurses and other caregivers on how they can exercise their freedom of expression responsibly and does not cause lateral violence in the setting of the workplace. It will help to overcome the ethical challenge of possibly suppressing freedom of expression and hence provide an ethical framework for the implementation of this change.

Another ethical challenge relates to the fact that it forces people to associate and communicate nicely even when they naturally hate them. Interpersonal relationships and communication should come naturally, and people have a right to associate with the people and disassociate with the people that they do not like. Consequently, an environment which forces people to associate and talk nicely to people they naturally do not like may worsen the situation. Moreover, the implementation of this change may define lack of interest in associating with an individual as lateral violence. The ethical challenge in the implementation of this change is to draw the distinction between respectful association and communication and forced association. Understanding this distinction will be paramount in addressing the ethical challenge.

Lastly, nurses have the ethical obligation of highlighting and addressing practitioner impairments both in themselves as well as in other nurses. The nature of the nursing practice and the overall healthcare system is that it deals with the lives of people. As such, nurses have the moral obligation to identify and correct any malpractices in themselves as well as in other nurses and caregivers that could put the lives of the patient at risk. The ethical dilemma in the implementation of this change system is distinguishing these corrective utterances and lateral violence.

Lastly, the implementations of this change possess a challenge on the ethical responsibility of nurses to criticize each other positively as a way of enhancing service delivery. Positive criticism plays a role in continuously improving the ability of individual nurses as well as the entire healthcare system in the provision of quality healthcare. However, the implementation of this change limits the possibility of positive criticism since such may be deemed as lateral violence against other nurses. As such, it takes away the fundamental ethical responsibility of nurses to keep each other in check through positive criticism.