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1. What Impact Does Workplace Violence Have on Nurses Essay
What Impact Does Workplace Violence Have on Nurses Essay ON What Impact Does
Workplace Violence Have on Nurses EssayWorkplace violence against nurses is a major
challenge for healthcare leaders. Common types of violence such as physical harm, sexual
abuse, aggression, mobbing and bullying can occur from patients, family and co-
workers.What impact does workplace violence have on nurses, other clinical staff and the
organization as a whole? Be specific and provide rationaleHow is workplace violence
addressed in your organization, i.e. policies, protocols, training. Be specific. Is it sufficient?
What else could be done?What are the legal and ethical implications for the nurse leader if
workplace violence occurs on their unit(s)?must contain minimum of two (2) references, in
addition to examples from your personal experiences to augment the topic. The goal is to
make your post interesting and engaging so, others will want to read/respond to it.
Synthesize and summarize from your resources in order to avoid the use of direct quotes.
No direct quotes are allowed in the discussion board posts.References:Initial Post:
Minimum of two (2) total references: one (1) from required course materials and one (1)
from peer-reviewed references.Response posts: Minimum of one (1) total reference: one (1)
from peer-reviewed or course materials reference per response.What Impact Does
Workplace Violence Have on Nurses Essayattachment_1Unformatted Attachment
PreviewOriginal Article Workplace violence against nursing staff in a Saudi university
hospital Hanan A. Ezzat Alkorashy1,2 Moalad3 RN, MScN BScN, MSc, PhD & Fawziah
Bakheet Al 1 Assistant Professor, Nursing Administration Department, Faculty of Nursing,
Alexandria University, Alexandria, Egypt 2 Assistant Professor, Nursing Administration and
Education Department, College of Nursing, King Saud University, Riyadh, KSA 3 Director of
Nursing Services, King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia
ALKORASHY H.A.E. & AL MOALAD F.B. (2016) Workplace violence against nursing staff in a
Saudi university hospital. International Nursing Review 63, 226–232 Background: Violence
against nurses is a major challenge for healthcare administrators. It is gaining more
attention because it has a negative impact on nurses, the quality of health care and health
organization. Common types of violence include physical harassment, sexual abuse,
aggression, mobbing and bullying. Patients, their relatives and co-workers are considered
the main perpetrators. Aim: To determine the prevalence rate of workplace violence against
nursing professionals in a university hospital in Riyadh, Saudi Arabia, most frequent type
and perpetrators as well as the contributing factors. Methods: This quantitative cross-
sectional study adapted a survey questionnaire from the Massachusetts Nurses Association

2. Survey on Workplace Violence/Abuse to collect data from a quota sample of 370 nursing
personnel. Results: Almost half of the participants had experienced violence in the
professional setting during the 12 months prior to the study. The majority of subjects
perceived workplace violence as verbal abuse. Nearly all nursing professionals identified
patients as the leading cause. Slightly more than half mentioned understaffing,
misunderstandings, long waits for service and lack of staff training and policies for
preventing crisis as contributing factors. Conclusion and Implications for Nursing and
Health Policy: The prevalence rate is extremely high among nurses in the targeted Saudi
university hospital. Saudi health as well as university hospitals’ administration and policy
makers should adopt and introduce a ‘zero tolerance policy’, set standards and develop
practical measures for preventing the incidence and for controlling the prevalence of
violence against nurses. Besides, healthcare organizations, particularly hospitals, can fulfil
their obligations to provide both staff and patients with more secure environment. Further
research on the topic is needed. Keywords: Hospitals, Nursing staff, Saudi Arabia, Teaching
hospital, Workplace violence, mobbing, bullying, harrassment, abuse, violence
Correspondence address: Hanan A. Ezzat Alkorashy, Nursing Administration and Education
Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia; Nursing
Administration Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt;
Tel: +966553121296; Fax: +966118050835; E-mails: halkorashy@ksu.edu.sa;
hanan_alkorashy@yahoo.com. Conflict of interest No conflict of interest has been declared
by the authors. Funding This research project was ed by a grant #GSS-212-668 from the
“Research Center of the College of Nursing”, Deanship of Scientific Research, King Saud
University. © 2016 International Council of Nurses 226 Workplace violence against nursing
staff Introduction Workplace violence (WPV) is a serious organizational issue in all
countries and is strongly linked to inappropriate healthcare outcomes. According to the
World Health Organization (WHO 2002), WPV refers to occupational settings or incidents
wherein workers are threatened, abused or assaulted. Verbal harassment, abuse, threats
and bullying are common examples of WPV. Subtle behaviours and coercion are also
considered types of WPV (Dionisi et al. 2012, p. 398). WPV against nursing professionals
continues to increase within healthcare organizations (Kuehn 2010). The International
Council of Nurses (ICN) acknowledged WPV as a significant issue in nursing and requested
that attention be given to clinical issues and competence in dealing with violence (Franz
2010). Nursing professionals are the leading victims of WPV worldwide. Verbal misconduct
and threats by patients and other staff members against new nursing professionals are
common (Teferralikassa & Jira 2015). What Impact Does Workplace Violence Have on
Nurses EssayTeaching hospitals in Saudi Arabia, as in many other countries, serve a large
number of patients and provide patients with free services; therefore, many patients seek
medical and nursing care. However, the presence of medical students and medical, nursing
and paramedical staff lead to difficult working conditions and hospital overcrowding and
result in nurses’ overload, stress and lack of interest in work (Teferralikassa & Jira 2015).
Moreover, studies have shown that specific features of the workplace site such as poor
working conditions, poor lighting, low security, a high number of hours worked and poor
staffing are known risk factors for WPV (AbuAlRub & Khawaldeh 2014; Banerjee 2008).

3. Additionally, nurses’ attitudes and witnessing previous workplace assaults have been
reported as risk factors contributing to future assaults (Spector et al. 2014). Concomitantly,
no effective prevention protocol or official reporting method about violence in Saudi
healthcare settings is available. Literature review International studies have reported high
prevalence rates of WPV against nurses: ranging from 6% up to 74% (Esmaeilpour et al.
2011; Kennedy & Julie 2013; Pai & Lee 2011; Speroni 2014; Talas et al. 2011). For the
regional prevalence, several Arab studies have shown a rapid increase in the prevalence of
WPV against nurses and ranged between 7% and 91.6% (Abbas & Selim 2011; AbuAlRub &
Khawaldeh 2014; Deeb 2003; Taher 2010). Concomitantly, in the Kingdom of Saudi Arabia,
the situation is comparable (Algwaiz & Alghanim 2012; Almalki et al. 2012). © 2016
International Council of Nurses 227 An enhanced understanding of the risk factors of WPV
will help identify strategies to prevent WPV (Esmaeilpour et al. 2011). The main factors
influencing WPV include gender, age, education and previous experiences (Taher 2010).
Patients, relatives, healthcare workers, and visitors are common sources of WPV (Angland
et al. 2014; Esmaeilpour et al. 2011). Communication barriers can also result in an
increased risk of WPV (Shafipour et al. 2014). In this context, Shafipour et al. (2014) stated
that effective and appropriate communication is necessary between nurses and patients for
the delivery of health care. Impaired communication will result in the patients’
disappointment and anger. The negative consequences of widespread WPV significantly
affect the delivery of healthcare services, reducing the quality of care and increasing the
number of healthcare workers leaving the profession (World Health Organization (WHO)
2002). Aims of the study This study aimed to determine the prevalence rate of WPV against
nurses in a Saudi university hospital and to identify the common types, perpetrators and
precipitating factors of WPV, as well as its impact on nurses. Methods Setting and
Participants This cross-sectional study was conducted in an 860-bed university hospital in
Riyadh City, Saudi Arabia. It used a quota sample of bedside nurses (n = 425) and all head
nurses and charge nurses (n = 75). From the accessible population (n = 1232), the sample
size was calculated using the G*power 3.0 program. The number of subjects needed to
achieve an effect size of 0.3 (medium), a level of significance (a) of 0.05, and a test power (1
b) of 0.95 was 293. As the inclusion of participants was not random (convenience instead),
the sample was further increased by 15% to account for contingencies such as non-
response and/or potential drop-outs, bringing the final sample size to 500 nurses. The
inclusion criteria were professional nurses working in all/some of the shifts, those in
technical or administrative positions, those with at least 1 year of experience in the selected
setting, and those who were willing to participate in the study. Study instrument This study
adapted the survey questionnaire from the Massachusetts Nurses Association Survey on
Workplace Violence/ Abuse, with a permission. The questionnaire was developed in English
language, validated and used in a previous study conducted by the Massachusetts Nurses
Association Congress 228 H. A. E. Alkorashy and F. B. Al Moalad on Health and Safety and
Workplace Violence and Abuse Prevention (MNA 2008). The questionnaire contains 40
structured multiple-choice questions related to the prevalence of WPV, forms and
perpetrators as well as precipitating factors for WPV. As the official language in the work
setting is the English language, the decision was no translation was required and the

4. questionnaire was used in its original language. A pilot study on 30 participants had been
conducted. Two words were changed: “Union representative” in question 13, was changed
to “hospital security office” because there is no union in KSA and in question 20, “Employer”
was changed to “hospital” and “tolerating undesirable behaviour, such as violence” instead
of “zero tolerance policy” because the latter was not clear for the most of the subjects in the
pilot study. The reliability for the tool was determined by Cronbach’s alpha (a = 0.7615).
Data collection The self-administered questionnaires were distributed to the participants
after receiving approval to conduct the study from the research/ethical committee and the
administration of the university hospital. The data were collected from March to May 2011.
Perceptions of WPV by violence experience and job category The results of this study
revealed that more nurses who had experienced WPV perceived it as verbal abuse (v2 =
27.838, P < 0.001), and consider it as a serious problem (v2 = 107.484, P < 0.001) as
compared with those who had not experienced WPV. On the other hand, more nurses who
had no experience with WPV perceived it as physical attacks compared with those who had
experienced WPV (v2 = 4.885, P = 0.027) (Table 1). Perpetrators and forms of violence
Participants who had experienced WPV in the 12 months prior to data collection (n = 175)
were asked to indicate the form and source of the violence. From all violence incidents (n =
1103), all the participants identified patients as the main perpetrators (f = 204), followed by
the patients’ relatives (f = 195). Verbal abuse was the most frequently reported forms of
violence 435 (38.5%) exhibited by the 99 (56%) physicians, 89 (50.9%) patients and 82
(47.0%) patients’ relatives. Followed by verbal or written threats, 289 (27.4%); and
threatening behaviours, 226 (19.6%) (Table 2). Precipitating factors of WPV Data analysis
The data were analysed using descriptive and inferential statistics. Spearman’s chi-square
test had been used to compare variables across groups and to investigate the relationship of
selected demographic characteristics with the perceptions of WPV. Several factors
contribute to the emergence of WPV against nurses. These include organizational,
individual and situational Table 1 Variance between the perceptions of WPV of those with
and without WPV experience Perception of nurses Ethical considerations The content and
method of this study was approved by the college of nursing administration, in the target
Saudi university, the research centre (IRB# 10-2576) and the ethics committee (EC#
14158) of the target hospital setting prior to study conduction. The participants signed an
informed consent form after being informed about their information anonymity and
voluntary participation. Results From the 500 distributed questionnaires, 404 were
returned, resulting in a response rate of 80.8%. Among the returned questionnaires, 34
were excluded due to insufficient answers or missing data. Thus, 370 questionnaires (74%)
were used for analysis. What Impact Does Workplace Violence Have on Nurses EssayThe
majority of participants were staff nurses (80.3%) and worked 8-h shifts (54.2%).
Moreover, most of the nurse participants were female (93.2%), aged 31–39 (35.8%) or 26–
30 (24.8%), married (70%), Asian (83.9%) and held a diploma degree (61.6%). © 2016
International Council of Nurses Yes (n = 175) Definition Verbal abuse 147 (83.9)
Verbal/written threats 117 (66.8) Threatening behaviour 97 (55.7) Physical attack 82
(46.9) Sexual harassment 55 (31.6) Sexual assault 41 (23.6) All of the above 36 (20.7)
Seriousness of violence problem Very serious 25 (14.0) Somewhat serious 56 (32.1) Not

5. sure 17 (9.6) Not too serious 57 (32.6) Not at all serious 21 (11.7) *Significant at P < 0.05.
v2 (P) Suffered violence experience No (n = 195) 133 121 103 106 73 57 46 (68.15) (62.3)
(53.0) (54.6) (37.3) (29.2) (23.4) 27.838* (<0.001) 1.858 (0.173) 0.594 (0.441) 4.885*
(0.027) 2.888 (0.089) 3.270 (0.071) 2.421 (0.075) 4 28 42 68 52 (2.1) (14.6) (21.5) (35.0)
(26.9) 107.484* (<0.001) Workplace violence against nursing staff 229 Table 2 Frequency
of exposure to forms of violence from different perpetrators as reported by nurses who
experienced violence (n = 175) Form of violence Verbal abuse Verbal/written threats
Threatening behaviour Physical attack Sexual harassment Sexual assault Total*
Perpetrators f (%) Patient Patient’s Relative Physician Supervisor Nurse Others Total† 89
42 30 34 8 1 82 46 52 9 6 0 99 39 33 0 6 0 64 69 32 0 5 5 83 40 26 10 16 0 18 (10) 53 (30)
53 (30) 0 (0.0) 44 (25) 9 (5) 177 435 (38.5) 289 (27.4) 226 (19.6) 53 (5.03) 85 (8.1) 15
(1.4) 1103‡ (50.9) (23.8) (17.2) (19.6) (4.7) (0.8) 204 (47.0) (26.1) (29.7) (5.2) (3.4) (0.0)
195 (56) (22.0) (18.6) (0.0) (3.4) (0.0) 177 (36.4) (39.4) (18.2) (0.0) (3.0) (3.0) 175 (47.2)
(22.6) (15.1) (5.7) (9.4) (0.0) 175 *Exposure to specific perpetrator. †Exposure to specific
form of violence. ‡Total number of violence incidents of all forms from all perpetrators.
factors. The findings indicated that understaffing, particularly during meal times and
visiting hours, was the most frequently reported factor (53.6%) by the participants.
Moreover, “misunderstandings” was cited due to the communication barrier among nurses
and patients (54.4%) and “working directly with volatile individuals” (42.5%). About a third
(32.6%) of the participants reported “long waits for service” and a similar proportion
(31.9%) cited “inadequate security” as factors leading to WPV. “Lack of staff training and
policies for preventing crisis” was the only organizational factor that showed a statistically
significant difference between groups (v2 = 5.375, P = 0.020); it was reported more
frequently by staff nurses (24.9%) than by nurse managers (12.3%) (Table 3). Table 3
Precipitating factors of WPV reported by participants according to job category (n = 370)
Factors Organizational factors Working when understaffed Poor environmental design Lack
of staff training and policies Overcrowded, uncomfortable waiting rooms Unrestricted
movement of the public Poorly lit corridors, rooms, parking lots Individual factors Working
directly with volatile people Working alone Drug and alcohol abuse Personal problem of co-
worker Misunderstanding Situational factors Inadequate security Concern of patients
Access to firearms Transporting patients Long waits for service *Significant at P < 0.05. ©
2016 International Council of Nurses Nurse Mgrs (n = 73) Staff Nurses (n = 297) Total v2
(P) 35 3 9 5 6 1 (47.9) (4.1) (12.3) (6.8) (8.2) (1.4) 163 35 74 38 20 10 (55.0) (11.8) (24.9)
(12.8) (6.7) (3.2) 198 38 83 43 26 11 (53.6) (10.4) (22.5) (11.7) (7.0) (2.8) 1.169 3.790
5.375* 2.021 0.207 0.712 (0.280) (0.052) (0.020) (0.155) (0.649) (0.399) 26 13 12 10 40
(35.6) (17.8) (16.4) (13.7) (54.8) 131 47 40 59 161 (44.1) (15.7) (13.4) (19.8) (54.3) 164 62
54 72 210 (42.5) (16.1) (14.0) (18.7) (54.4) 1.739 0.204 0.449 1.456 0.006 (0.187) (0.652)
(0.503) (0.228) (0.941) 30 15 1 12 22 (41.1) (20.5) (1.4) (16.4) (30.1) 88 64 3 41 99 (29.7)
(21.7) (1.0) (13.7) (33.2) 118 79 4 53 121 (31.9) (21.5) (1.0) (14.2) (32.6) 3.533 0.049
0.098 0.353 0.257 (0.060) (0.826) (0.755) (0.552) (0.612) 230 H. A. E. Alkorashy and F. B. Al
Moalad Discussion The findings of this study revealed that nurses’ perceived level of WPV
was lower than that of previous studies. Various factors that may trigger violent incidents
against nurses in hospital settings were identified. Jordan et al. (2010) argued that nurses’

6. perception of WPV is subjective; therefore, it may be interpreted in different ways. Howard
(2011) found that participants perceived some acts as more representative of WPV than
others. This is consistent with the current study findings, which showed the participants’
varied perceptions of the definition of WPV and their lack of understanding of the term.
Almost all the nurses regarded WPV as verbal abuse and verbal/written threats. In the
present study, nurses who had experienced violence defined it as verbal abuse, while those
who had not experienced violence perceived it as a physical attack. Most participants did
not perceive violence as a serious problem in their work setting. Thus, nurses are not fully
aware of the violence occurring around them. This result is consistent with that of Mueller
& Tschan (2011), who found that nurses usually perceived violent incidents by the patients
as less serious than violent incidents by the employees. What Impact Does Workplace
Violence Have on Nurses EssayThey also found that workers in healthcare institutions often
bear with the patients’ violent behaviours in clinical settings. In the present study, the
participants who had experienced a violent incident were asked about its causes. The most
commonly reported causes were miscommunication and anger. Miscommunication was a
frequently cited cause because most of the participants were non-Arab nurses and most
patients and their families did not speak English, which created a communication barrier.
Additionally, interpersonal communication between the staff members was occasionally
ineffective because the nurses belonged to different nationalities and had different cultural
backgrounds, principles, values, attitudes and experiences. This cultural diversity can
increase the risk of interpersonal conflict, leading to violence. Hahn (2010) also found that
impaired verbal communication about therapeutic planning is associated with an increased
risk of WPV. Nursing professionals should know that the patients and their visitors could
show inappropriate emotions, aggressiveness and violent behaviour at the time of
treatment. These factors are the leading causes of WPV (Bowie et al. 2002). Taher (2010)
suggested that thorough and respectful communication with patients and their companions
must be initiated in the early stages of treatment. Communication with patients should
include clarifying expectations and explaining standard procedures, which would lessen
frustrating situations. Nurses are one of the professional groups who are at risk of WPV
(Gates et al. 2011). In the current study, approxi- © 2016 International Council of Nurses
mately half of the subjects suffered from at least one form of WPV in the year prior to data
collection. This result is consistent with those of many studies conducted in Arab and
foreign countries. The incidence rate of WPV in these studies ranged from 50% to 86%
(Almalki et al. 2012; Lim et al. 2010; Newman et al. 2011). The findings of this study
revealed that patients and their families were the most frequent perpetrators of violence
against nurses. This finding is inconsistent with the findings of other studies examining
WPV in healthcare settings (Al-Omari 2015; Cashmore 2012; Fujishiro et al. 2011; Pai & Lee
2011; Taher 2010). Fujishiro et al. (2011) revealed that nursing colleagues, seniors,
managers and doctors were the primar …What Impact Does Workplace Violence Have on
Nurses Essay