APNA 30th Annual Conference Session 3011: October 21, 2016 ABOUT PENN MEDICINE The Aftermath of Violence: The Lived Experience Phenomena of Assault in Nursing The University of Pennsylvania Health System was created in 1993 and consists of five hospitals (Hospital APNA 30 th Annual Conference of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, Chester County Hospital, Lancaster General Hospital), a faculty practice plan, a primary care provider network, multi- specialty satellite facilities, home care, hospice and a Session: 3011.1 nursing home. Friday, October 21 st 2016 12:00pm-12:45pm Licensed Beds 2,503 Total Employees 31,235 Kathleen Clark, PhD, RN, PMHCNS-BC Admissions 118,445 Outpatient Visits 4,734,948 Nurse Manager for Crisis Response Center Physicians 5,314 Pennsylvania Hospital-Penn Medicine, Philadelphia PA Nurses 6,793 4 Disclosure Assault in Nursing: The presenters for this presentation have disclosed no conflict of interest related to this topic. The Lived Experience 2 5 Violence in the Workplace Learning Objectives • 80% of nurses do not feel safe at work (Peek-Asa, et al., 2009). • Discuss the epidemic of physical violence against nurses in the workplace. • Of those working in health care, nurses are the group most frequently assaulted in the • Examine the lived experience of nurses returning to work post-assault by a workplace (Findorff, et al., 2004). patient, with a focus on resiliency concepts. • Explores tools that can be utilized to foster healthy adaptation in nurses who • Among all health care workers, nurses have the highest rate of violent victimization at experience adverse events in the workplace. work with over 30,000 reported incidents of violence reported in the United States (Harrell, 2011). • 73% of nurses experienced some form of violence occasionally, 17% reported violence often, and 1.7% described workplace violence as always being experienced (Hader, 2008). 3 6 Clark 1
APNA 30th Annual Conference Session 3011: October 21, 2016 Impact on the Individual Nurse Current State Physical Impact • There are few studies that explore the lived experience of a nurse returning to work • From 1997 to 2009 there were 130 documented workplace homicides in the after assault. health care and the social assistance industry (NIOSH, 2012). Psychological Impact: • There has been no universal standard or benchmarked intervention that prevents • 17% met criteria for Post-Traumatic Stress Disorder (PTSD) immediately after the workplace violence. assault and, after 6 months 10% met the criteria for a diagnosis of PTSD (Richter & Berger, 2006). • Organizational commitment has focused on prevention, however workplace violence • 78% of workers exposed to work related violence experienced at least one prevention programs have not shown to be consistently effective across all health adverse symptom that included anger, irritation, sadness, or depression (Findorff, care organizations (Ferrell & Cubit, 2005). McGovern, & Sinclair, 2005). • Long term stress and trauma after an assault can have a cumulative effect leading a nurse to experience symptoms including apathy, flashbacks, crying spells, • Even in organizations that provide “Employee Assistance Programs” (EAP) for intrusive thoughts, and nightmares (Phillips, 2007). violence exposure, research has found most employees do not utilize the resources Exposure to violence can promote fear and can cause intent to leave the (Caldwell, 1992). organization where the violent episode took place (Rogers & Kelloway, 1997). 7 10 10 Purpose of Research Impact on the Organization • Absenteeism, productivity, and dissatisfaction with the work environment are losses • Gather an in-depth understanding of the lived experience of a registered that are not easily measured. nurse, employed in a high risk area, returning to work after experiencing an assault by a patient while on duty. • Research demonstrates workplace violence may contribute to low morale, decreased productivity, and increased errors (Ozge, 2003). • Empower nurses by providing them a voice. • Incidences of assault can contribute to burnout. “Burnout” syndrome is characterized • Address gaps in the literature related to the post-assault needs of nurses. by depersonalization which can manifest as withdrawal from work, both emotionally and behaviorally, and can effect the quality of patient care (Winstanley & Whittington, • Explore how to employ resiliency concepts to foster healthy adaptation in 2002). registered nurses after traumatic events at work. • It has been estimated that the cost of violence in the workplace is $4.3 million annually or approximately or $250,000 per incident, excluding hidden expenses experienced by the victim and/or their families (Murray, 2008). 8 11 11 Impact on the Profession Building Resilience in Healthcare Professionals • Research indicates that nurses are ambivalent about violence, particularly the notion of zero tolerance, suggesting that a degree of violence is, while not acceptable, is Life tolerated (Lovell & Skellern, 2013). is not about how fast you run or how high you climb, but • Violence is a social justice issue of because it is directed at members of a group simply because they are members of that group (Dubrosky, 2013). how well you bounce. https://ajem.infoservices.com.au/items/AJEM-31-02-09 9 12 12 Clark 2
APNA 30th Annual Conference Session 3011: October 21, 2016 Research Questions Research Design Question 2 – Positives: • Qualitative Phenomenology approach using “lived experience” • Appropriateness of research method What are the positive experiences when returning to the workplace after the • Appropriateness of research design assaultive incident? “I think it was after one • Study Population “It’s nice if we sat down and incident we actually debriefed it not only “For people to got...we never use to • Strategy immediately after the incident admit… yeah, that’s have an emergency but maybe a day or two later or pretty wrong what button.” • Sample Size “The only positive I when the person returns back happened… but it seemed like it was could take from it was to work.” • Recruitment & Participation the support I got from more like brushed my coworkers.” under the carpet.” • Inclusion criteria • Ethical Consideration • Instrumentation • Data Collection Procedures • Data Analysis Procedure Peer Support Debriefing Acknowledgement Control of Environment 13 13 16 16 Research Questions - Providing the Registered Nurse a Voice Thematic Analysis – Question 2 Question 1 – Returning to Work: Describe in detail what it was like when you returned to the workplace after Peer Peer Support Support the assaultive incident? “Everybody offered very good support like, ‘Are you okay? Do you need anything?’” “I just found myself being Positives Positives a little more reserved, just “ Your guard is much higher more vigilant of my Control of Control of because once you get hit After an After an surroundings just because it’s like the worst thing that Environme Environme Debriefing Debriefing I was just assaulted. I can happen” Assault at Assault at definitely pulled back.” nt nt “I felt anxious.” work work Acknowledgement Acknowledgement Distancing Peer Support Emotional Response Continued Exposure 14 14 17 17 Thematic Analysis – Question 1 Research Questions – Question 3 Question 3 – Negatives: Emotional Emotional What are the negative experience when returning to the workplace after the Response Response assaultive incident? “And this is really, really “Multiple staff members kind of dramatic but the thought gossiping… not gossip; I don’t think came and went, that I Returning Returning anyone was intentionally being should look for another job gossipy, but just spreading the word what am I? I must be about the incident and what had to work to work Peer Peer Continued Continued crazy?” occurred and people asking me if I “Well just that there was okay and drawing attention to it.” Support Support after an after an Exposure Exposure was always the unpredictability, you assault assault know?” Distancing Distancing Vulnerability Questioning Nursing Practice Negative Response from Peers 15 15 18 18 Clark 3
Recommend
More recommend