Horizontal Violence in Nursing Qualitative Research Proposal

1.1 Introduction

Horizontal violence (HV) has been defined by many authors and despite the definitions varying, the term has been mostly described as actions, words or other behaviors which are directed at one’s peers (Becher & Visovsky 2012), (Dumont, Meisinger, Whitacre & Corbin, 2012). The specific behaviors, words and actions are meant to humiliate, and injure the recipient’s dignity. Horizontal violence is aimed at demeaning an individual and having total disrespect towards them.

Tedone, (2020) defines horizontal violence in nursing as nurse-to-peer bullying. The author argues that bullying among nurse peers is an uncivilized act which has taken part over the years. Horizontal violence has been termed as a plague in the nursing profession. It is quite unfortunate that it has become an acceptable act for one nurse to demean the other without fear of consequence. One of the most crucial rhetorical questions one would ask is whether the human psychology system allows one nurse to bully the other. Nurses are always under pressure to provide optimum care to patients and most of the times, nurses are mentally prepared to conduct their responsibilities without interruption. However, when they encounter stress from the clinical realm or other external factors, the quality of their care decreases and this becomes a crucial issue when it comes to their performance.

The purpose of this essay is to write a proposal to a funding agency on the problems that nurses encounter in their profession. The essay will also establish reasons for the said funding.

1.2 Problem

One of the major problems in HV among nurses is that there is a cycle of silence. In an article by Tedone (2020), the author states that most nurses prefer to minimize confrontation from their peers because they may be labelled by their colleagues as snitches. Despite there being a code of conduct in the nursing profession, HV has become extreme and its roots are too deep, meaning crucial strategies may need to be implemented to mitigate the effects of HV among nurses.

The other problem of HV is that it results in long-term damage among nurses. Tedone, (2020) argues that nurses have been accused of “eating their young ones.” The phrase “young ones” has been used in place of the new nurses. The victim, who is “the young one” in this case, ends up with psychological torture and low self-esteem. A report by Stiehr and Smith (2014) shows that not only is HV a stressor for a nurse in the work environment, rather it is also steers psychological damage in the long term. The victims are likely to encounter depression, very low self-esteem, reduced productivity at work and truancy. Bloom (2019) concurs with Stiehr and Smith (2014) on the effects of HV on nurses. Bloom (2019) goes further to add that victims are likely to have low concentration, increased stress level, and frequent frustration.

The cost of horizontal violence among nurses is a problem that the funding agency needs to understand. A study conducted by Hassard, Teoh, Visockaite, Dewe, and Cox (2018) shows that the total cost of psychological aggression at the workplace is $114.64 million to $35.9 billion. The study was analyzed from five developed countries including US, UK, Spain, Italy and Australia. The study argues that there has been increased incivility among nurses in the United States and the cost has been approximately $24 billion annually. The study also revealed that the cost for each nurse in the ICU was approximately $145,000. The costs described are those incurred in efforts of treating nurses who have been bullied. The costs also include the amount of productivity a health facility may have lost as a result of HV.

Stopping the cycle is a key problem for healthcare institutions. First, most institutions prefer not to let people know that “nurses are eating their young ones” (Tedone, 2020). It may sound pervasive at first but it has detrimental effect to the victims. While most healthcare institutions aim at improving their image, there do not want to let news out that they are experiencing HV. It may be ironical for the public to hear that the so-called caring professionals do not to care for each other.

The most crucial limitations that victims of HV encounter include confronting their aggressor, making a formal complaint to the organization, taking legal action, getting help from employer or gaining control of the situation. HV is mostly related with intimidation and those involved are new nurses in the profession. New nurses may require motivation and empowerment to fight for their rights. Psychological torture is a serious concern as it could have a negative effect on both performance and the long-term wellbeing of an individual (Weaver, 2013). It would be important for the funding agency to establish ways of mitigating the risk of new and existing nurses getting involved in HV during their time as nurses. The trickle-down effects of HV to an institution creep in slowly and cause psychological and financial damage to an institution.

1.3 Significance

The significance of the proposal is to get the funding agency to look into the grievances of nurses who are largely affected by HV. The proposal is also aimed at informing the funding agency on healthy work environment that nurses require as they care for patients. This will involve a lot of financial and psychological support from the institution or willing sponsors.

Assessing the type of violent and abusive words and behaviors in healthcare institutions by the funding agency will provide a clear view of the entire ordeal and hence help in making strategic steps towards mitigating HV and provision of a healthy work environment for nurse.

1.4 Feasibility

A funding agency would be the most reliable institution that would assist nurses who have already encountered HV in their profession heal from it. The funding agency will act as a sponsor to nurses with psychological problems including depression, aggression and low self-esteem.

Evidence from the research will assist in the establishment of the extent to which nurses in the healthcare sector have suffered as a result of HV at work. The funding agency is required to help with the cost of treatment for nurses and also help to bridge the gap in productivity in the healthcare institutions.

2.0 Literature Review

2.1 Theoretical Review

2.1.1 The Nurse as the wounded healer

Nursing is a profession where one needs to help people in a vulnerable state. The scholars Christie & Jones (2014) argue that people are led to professions such as nursing by a desire to help people and relive their suffering. The authors argue that there is a likelihood that people who become nurses have in the past come across persons who have encountered traumatic situations in their lives and therefore they would prefer acting as problem solvers. Kalsched (2014) goes further to argue that every individual has experienced trauma in their life but at different levels. Waldeck (2011) argues that the wounded healer is that person who has been damaged by past experiences and would rather provide solutions to the world.

2.1.2 Nursing as an oppressed Discipline

Most of the time, people will always feel inferior when they are at the bottom. The health care system has a hierarchy and most of the times, nurses are at the bottom. Furthermore, amongst nurses themselves, there is also hierarchy (Tedone, 2020). The author argues that some nurses become aggressive towards their peers in an effort to relive tension that has been built within the system.

2.1.3 Low self-esteem.

Research shows that most nurses in the world are women. Women have also been considered the inferior gender and hence some professions considered women-dominated are not assigned the value that they deserve. This could give raise to low self-esteem among practitioners in such professions. People with low self-esteem are easily angered and cannot manage themselves. Such individuals can easily lash at others without being considerate.

2.1.4 Disenfranchising work practice

Nurses are under pressure of attending to patients and attending to other diverse functions. Most nurses end up being overwhelmed by the workload (Tedone, 2020). Peers who are overworked could be easily irritable and end up being perpetrators or victims of HV at the workplace.

2.2 Empirical Review

In a study by Bloom (2019), the author carries out a research on HV as an overt and covert behavior of hostility. The study conducts an online survey and examines 76 hospital nurses on their experiences and responses to HV. The nurses in the survey argue that HV is an act that happened to them when they were newbies in their career. Increased workload was among the major factors that increased the rate of HV in hospital as a result of aggression and stress levels. The nurses also argued that despite HV being rampant, they still continued with their jobs. The study established that HV is costly and results to increased turnover rates for nurses, low quality of patient care, and increased levels of illness. The limitation of the research is that the author is unable to establish reasons the victims still continued working at the facilities despite facing HV.

Another study was conducted by Egues and Leinung (2013) on the bully within and without in the context of HV in nursing. The study collects data and information from nurses through workshops. Nurses are required to provide information on their experience of horizontal violence at their work places. One of the findings in the study is that nurses have knowledge about horizontal violence and ways to deal with the phenomenon. However, despite there being ways of mitigating the act, the facilities do not follow protocol. From the study, it is clear that nurses need exposure on matter relating to HV. Victims also need to be protected and counselled.

3.0 Research Design

3.1 Conceptual Framework

The conceptual framework will propose the causal relationship among the variables that will be hypothesized. Horizontal violence in this case will be the independent variable and all the other variables such as, aggression, low self-esteem and psychological torture will be influenced by HV. Furthermore, the other independent variables in regards to the topic include stress levels and oppression at the work place. The reason for suggesting such variables is that they could be the reason nurses engage in HV at health care facilities. It could be that when nurses become stressed with work, they turn against their peers and demean them.

The conceptual framework will present a means of communication between senser and receiver of the message. The framework will clearly present the different variables that have a causal effect on each other.

The Independent variables include:

· Oppression

· Stress levels

Horizontal Violence

The dependent variables include:

· Quality of patient care

· Psychological disorders

· Depression

· Low self esteem

Self esteem

Psychological disorders/Mental Illness

Depression

Quality Care

Horizontal Violence

Oppression: Oppressed self Stress Levels

Oppressed group

3.2 Design

Hypothesis

Ho: HV does not negatively affect nurses

HA: HV affects nurses negatively

4.0 Methodology

4.1 Sample

An online survey will be conducted to ensure many nurses can engage in the survey. The survey will establish the age, gender and years of experience of a nurse. This will enable us to evaluate the most likely gender and age group that is affected by horizontal violence. Furthermore, in our research we will go further into conducting interviews with willing respondents. This will enable us to gauge the level of sincerity and the extent of HV in health care facilities. We also plan on visiting HV victims in hospitals where they are receiving medication. This will enable us to get the spectrum of the whole situation.

Descriptive statistics will be used to analyze qualitative data. Time series will be collected and a regression analysis conducted on the quantitative data. The sample size will be divided based on gender.

4.2 Plans for Data Collection and Analysis

A website will be created and the link shared to the respective individuals. The website will be specifically designed with the survey questions. The website will be simple to ensure that respondents can easily maneuver their way through. There will be absolute discretion as none of the correspondents will be required to provide their names. The name of the hospital where the HV was experienced may or may not be stated. This may depend with the respondents’ sentiments at that specific time.

We will also engage in a discussion on the amount of money those different victims of HV have incurred in their attempt to save themselves from the adverse effects of HV. We plan to discuss the effects of HV on victims. The possible discussions will revolve around self-esteem, depression and quality care. Moreover, hospitals that may be accused of having promoted HV will be evaluated and the quality of care scrutinized. There will be a contrast between hospitals with HV and those without HV encounters.

We will search different hospital websites and evaluate their performance. We will then compare the different performances and whether they have any relation with HV. For firms that have been highly accused of HV, scrutiny will be made to establish previous and current performance. Quantitative analysis will be conducted on hospital performance. This will help us gauge the impact of HV on quality care and hospital productivity. Time series data may therefore be collected on the different variables. This will include productivity in terms of revenue. Data will also be collected on the number of times when nurses miss work. Essentially, a higher frequency will mean that HV has a high negative impact on nurses and their profession.

4.3 Budget

We aim to provide a budget with regard to assisting nurses recover from psychological disorders as a result of HV. The budget amount that we request from the funding agency is to assist us with our research. Our research is aimed at evaluating a crucial problem in the society and establishing ways of mitigating its effects on the victims.