Professional Accountability and Patient Safety

Assessment 3: Professional Accountability and Patient Safety Defining the Issue: Violence from Patients towards Nurses: In this discussion, I concern myself with ‘violence from patients towards nurses.’ It is important to note, from the onset, that violence meted to nurses by patients is one of the least discussed contemporary nursing issues. In the words of Stevenson, Jack, O’Mara and LeGris (2015, p.

32), “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.” In essence, violence from patients towards nurses includes any act of aggression initiated by the patient and (or) their relatives and friends and directed at the nurse. Acts of aggression in this case could include, but they are not limited to, grabbing, scratching, hitting, and in some cases shouting down the nurse in a threating manner.

It is important to note that in some extreme instances, nurses have been killed by those they are attempting to take good care of. Patients likely to become violent towards nurses, as Ramacciati, Ceccagnoli, Addey, Lumini, and Rasero (2016, p. 23) point out include those having mental health issues and those under drug influence. Significance to Nursing According to Roche, Diers, Duffield, and Catling-Paull (2010, p.

14), the fact that nurses offer front-line service and are in close proximity to patients makes them prime “targets for interpersonal violence.” The services nurses provide to patients in the healthcare setting are largely hands-on. This puts them in close proximity to patients so that they can be able to not only administer medications, but also monitor the condition of patients. Further, nurses act as an important link between patients and doctors and maintain key records relating to the health condition and progress of patients.

The relevance of nurses in the healthcare setting cannot, therefore, be overstated. Anything that disrupts the effective functioning of nurses in this setting is therefore a threat to the smooth functioning of the entire health system. It is important to note that as Stene, Larson, Levy, and Dohlman (2015, p. 114) point out, most violence from patients towards nurses is observed in the emergency room. Violent altercations in the emergency room can disrupt the flow of activities and effectively disadvantage other patients.

Nurses contend with a myriad of challenges in the discharge of their duties. Common challenges include working long hours, handing the anguish of family members and families following death of a loved one, ensuring that patients honor their treatment regimen even in those instances when they (patients) do not want to, etc. Violence at the workplace is yet another issue nurses have to contend with. It is important to note that as Stevenson, Jack, O’Mara and LeGris (2015, p.

37) point out, violence from patients towards nurses does take a toll on not only the physical, but also the emotional wellbeing of nurses. While physical effects could manifest in the form of physical injuries and disabilities, emotional pain includes stress and depression. As Arnetz, Hamblin, Essenmacher, Upfal, Ager, and Luborsky (2014, p. 340) point out, patient-related violence towards nurses need not be physical.

As a matter of fact, the most common instances of violent and aggressive behavior towards nurses are verbal abuse, which in most cases takes the form of swearing (McNamara, 2010, p. 676). In instances where the said violence goes on for a significant period of time without being addressed, significant psychological trauma could set in. In some instances, emotional harm could be extensive and long-lasting – causing irreversible damage to the affected nurse’s wellbeing, in which case problems such as nightmares, palpitations, etc. become commonplace.

Violence from patients towards nurses could also end up affecting the nurse’s abilities to effectively perform their duties – effectively leading to suboptimal performance at the work setting, particularly as a result of emotional trauma. This could manifest itself via absent mindedness, etc. Also, when the effect of violence from a patient is extremely traumatic, the nurse may have to miss a few days (or weeks) of work (McNamara, 2010, p. 674). This effectively leaves their work centers and stations without adequate staffing.

In essence, therefore, violence from patients towards nurses does have far reaching impacts on nursing. Next, it should also be noted that when nurses are exposed to violent situations at the hands of their patients, this could result in changes in their attitude towards those they are supposed to take care of, and lead to loss of faith in this noble helping profession. As a matter of fact, as Cowen and Moorhead (2014, p.

190) observe, nurses have in the past changed profession as a consequence of constant exposure to violence at their places of work. In essence, this talent hemorrhage robs the profession of brilliant minds that could have been put to use to the benefit of patients and the entire nursing profession. On the basis of the impact violence from patients towards nurses has on both nurses and the profession, there is need for healthcare institutions to embrace the relevant strategies in seeking to protect nurses from patient violence.

These strategies will be explored elsewhere in this text. Impact on Patient Safety According to the World Health Organization –WHO (2018), patient safety has got to do with “the prevention of errors and adverse effects to patients associated with health care.” Generally, when nurses are subject of violence from patients, this could end up affecting their relations with the concerned patients. Strained relations could take the form of lack of affection and less empathy towards the said patients.

This is more so the case given the fact that it is basic human nature to feel offended when treated unfairly – more so when the perpetrators of the said treatment are beneficiaries of the affected party’s kindness. In some instances, the said empathy could be extended to other patients in the facility. Towards this end, the quality of care advanced to patients by nurses could suffer in two ways.

One, when the nurse is distracted by an actual threat or fear of violence (maybe as a consequence of a previous incident), this could affect their level of concentration and trigger erratic decisions and behavior in the course of delivering nursing care. Secondly, as a result of empathy, nurses could deliberately neglect their duties to a patient, effectively triggering adverse effects.

Examples of neglect of duties include but they are not limited to, late administration of medications, overdose or under-dose administration, and failure to fulfill some key duties to the patient (such as ensuring adequate ventilation, lighting, etc.) Next, violent patients, as Thomas, McIntosh, and Mensik (2015, p. 117) point out, could not only hurt nurses, but they could also end up hurting themselves in the course of an altercation.

This is more so the case when patients have IVs which could be altered as a consequence of a sudden jerk brought about by an anger fit. Similarly, falls as a result of a brawl could adversely affect patient outcomes. As it has been pointed out elsewhere in this text, adverse effects/outcomes to patients is identified by the World Health Organization as a component of patient safety, alongside medical errors. Instances of revenge cannot also be ruled out in situations involving violence from patients towards nurses.

As a matter of fact, we have had instances of nurses deliberately harming patients they harbor deep dislike for. The said dislike could be borne out of violence meted out to the concerned nurse by a patient. It is important to note that although some nurses are seasoned and have developed ways and strategies of dealing with situations such as these, others such as new graduate nurses may not be as experienced and could take matters into their own hands.

It is also important to note that when the environment of care is negatively affected, this could have adverse effects on patient safety. According to McNamara (2010, p. 679), “increased absenteeism, job dissatisfaction, and increased turnover further affect the environment of care.” In this case, the system of care delivery is disrupted leading to higher chances of the occurrence of accidents, injuries, as well as errors. As a matter of fact McNamara (2010, p.

681) points out that “the consequences of workplace violence have been shown to increase the potential for medical errors or adverse effects.” Measures to Minimize Impact on Nursing Practice and Patient Safety It is important to note that at present, the issue of violence from patients towards nurses has not been given the attention it deserves. This is more so the case given that as Wilson (2017, p. 114) points out, most incidents of violence towards nurses at their place of work go unreported.

Further, most healthcare institutions do not have in place adequate protections to ensure that instances of violence from patients towards nurses are prevented. According Wilson (2017, p. 116), violent incidents as well as the severity of attacks have been on the increase. Clearly, something needs to be done. To begin with, there is need for nurses to be offered adequate training on aggression management. This is more so the case given that in some instances, the aggression of a patient can be calmed if the appropriate approaches are used.

According to Roche, Diers, Duffield, and Catling-Paull (2010, p. 17), there is need to understand the most common causes of patient aggression so as to adopt the most workable approaches of reining in the same. Some of the more prominent causes of aggression, according to the authors, include pain, anxiety, loss of control, powerlessness, and disorientation” (Roche, Diers, Duffield, and Catling-Paull, 2010, p. 28). These are factors the nurse does nothing to trigger.

As the authors further point out, nurses ought to be aware of situations that could end up in violent altercations and ensure that preventive efforts are undertaken. Further, when in a violent situation, nurses should avoid confrontational moves as this could aggravate already aggressive patients even more (Wilson 2017). The nurse should retreat and seek the relevant help in such situations.

Training in aggression identification and minimization is therefore of essence so as to protect nurses from aggressive situations that could end up impacting negatively on their ability to practice and perform optimally. Ramacciati, Ceccagnoli,.