Clinical Question
Horizontal violence is identified as any hostile, forceful, and harmful acts by a healthcare provider towards a co-worker. It is expressed through actions, words, attitudes, and behavior. Such actions create an unsafe and unhealthy working environment, resulting in poor patient outcomes. Horizontal violence has adverse effects on the morale of the victim nurses and nursing students, sense of worth, mental and physical welfare. It also reduces the recruitment and retention of nurses (Llor-Esteban et al., 2017). Some nurses feel superior to others, especially the newly-hired, thus treating them with hostility by using abusive words or threats. The victims rarely report such cases due to fear of losing their job or making more enmity with other co-workers (Wolf et al., 2018). Violence can be based on gender, physical appearance, experience in nursing with recently-graduated nursing students being the largest victims, race, culture, religion, or ethnicity. The victims of horizontal violence end up quitting work or are always stressed, reporting to work late due to fear of encountering the bullies.
Understanding horizontal violence is significant as it helps determine the approaches that can be used to address the problem. The issue is essential in the dynamics of the culture of the nursing environment, retention of healthcare providers, and patient care. The effects of patient care cannot be overvalued in terms of insufficient care services, errors, or adverse impact resulting from high turnover from registered nurses leaving. When the hospital work environment is being assessed, the perceptions of nurses on bullying and possible intervention approaches should be included. The intervention methods chosen should concentrate on the managerial processes that will be used in handling workplace bullying. Intervention should also be done at the personal level (Cerit, Keskin, & Ekici, 2018). When new nurses are hired, the orientation should involve the introduction among co-workers. It will create understanding and promote respect. In addition, policy formulation against bullying should also be introduced, and it should include the code of conduct, that guides how nurses interact with each other (Bloom, 2019).
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Qualitative research is essential in formulating effective policies and developing methods of addressing bullying in healthcare effectively. The PICOT statement presented below will be useful in understanding the issue of bullying, the effects, and possible solution:
Population : Nurses and healthcare providers and nursing students; Place: hospital and nursing school
Intervention : Structured equation modeling, use of grounded theory using situational analysis, managerial intervention strategies
Comparison : Creating unity, peace, and respect among healthcare providers to reduce instances of bullying; comparing the performance of bullied nurses and those working in a peaceful environment.
Outcome : Reduced bullying and increasing understanding among nurses and healthcare providers
Time : bullying is an on-ongoing issues in healthcare, but can be reduced by advocating against it, creating workshops where providers interact, and implementing a policy against workplace bullying.
The purpose of this paper is to introduce researches conducted on the issue of bullying in the nursing environment, the effects at a personal and professional level, impact on patients, and possible intervention approaches.
Levels of Evidence
Qualitative and quantitative studies provide evidence on the type of research questions, thus guiding possible interventions. The types of questions in this study are determinant, aimed at establishing causes, effects, and intervention approaches of horizontal violence. In the research, evidence will be based on already done reviews and their outcome. One of the studies will involve situational analysis of forty-four emergency registered nurses. The study involved establishing how nurses react to an environment with greater or less levels of bullying (Wolf et al., 2018). The other quantitative research question involved establishing the effectiveness of using Bullying Behaviors in Nursing Education (BBNE). The study involved 442 nursing students, where testing was done using structured equation modeling. Complementary statistics were established as well as the aggressive actions reported by the nursing students’ tool (Cerit, Keskin, & Ekici, 2018). Llor-Esteban et al. (2017) used a qualitative research question on establishing how violence affects healthcare providers in emergency and mental health services units. A review of evidence from other studies is included, providing both statistical and report data. Bloom (2019) used mixed-method research to formulate several questions on horizontal violence among nurses. Evidence is derived from experiences, responses, and job performance measurements.
The best type of evidence in addressing violence issue in nursing is a mixture of different studies. Each provides a different level of proof. The situational analysis carried out by Wolf et al. (2018) presents level IV evidence due to the use of case-control studies. The cases involved are determining the effects of bullying in nursing dynamics. Llor-Esteban et al. (2017) and Cerit, Keskin, & Ekici (2018) researches provide level VI evidence. The studies involve describing the issue of horizontal violence, causes, and effects incorporating previously done studies. Llor-Esteban et al. (2017) use cross-sectional, descriptive-analytic design using various socio-occupational and psychological measurements. Cerit, Keskin, & Ekici (2018) uses a single descriptive qualitative study involving forty-four participants, with evidence being the professional effects of violence in nursing. Bloom (2019) used mixed-method research, thus providing level VI of evidence, involving responses from seventy-six nurses who undertook an online survey discussing their experiences on workplace bullying.
Search Strategy
The search terms I used during the study were: horizontal violence, workplace bullying, bullying prevalence in healthcare, nursing staff, anti-bullying policies.
I used Google Scholar and PubMed as the main databases to carry out the research. I found out that there are lots of articles, books, and journals written in response to the issue of horizontal violence in nursing. To narrow down the articles, I used the PICOT statement on the different elements as guidance.
The refinement decision was influenced by the availability of the keywords, publication date, relevance to the PICOT statement, the extent of evidence to support the research, and the credibility of authors. The limits were the type of database I chose, and these are Google Scholar and PubMed databases only. PubMed is known to published medical-related journals that have been researched on, thus contain reliable evidence that can be used to create change. Google Scholar is known to provide peer-reviewed articles that are reliable, valid, and credible. Therefore, the source materials I chose would have the evidence I need to learn about horizontal violence, its effects, and solution approaches suggested.
The two most important and supportive article that will offer direction on the next group work are “Development of Instrument of Bullying Behaviors in Nursing Education based on Structured Equation Modeling” by Cerit K , Türkmen Keskin S , Ekici , and “Workplace bullying in emergency nursing: Development of a grounded theory using situational analysis” by Wolf LA , Perhats C , Clark PR , Moon MD , Zavotsky KE . These articles have combined both descriptive and statistical data, thus presenting high levels of evidence. These articles provide a lot of data that helps to gain an in-depth understanding of the problem of bullying in healthcare, all causes, effects, policies formulated to deal with bullying, and how management is addressing the issue. The information can be useful in exploring further research questions for the future on how healthcare organizations can improve workers' relationships to address violence among providers.
Conclusion
The process of research determines the type and level of evidence acquired. Effective research needs to be done and choosing reliable sources to get the best evidence. The best sources are selected from authentic databases and contained different types of studies conducted to find evidence. PICOT statement guides the type of article to be chosen and the information required. In this study, evidence indicated that horizontal violence has both personal and professional effects on the victims. The healthcare center also suffers due to high turnover rates. The problem can therefore, be addressed by introducing anti-bullying policies and management addressing the issue.
References
Bloom, E. M. (2019, January). Horizontal violence among nurses: Experiences, responses, and job performance. In Nursing forum (Vol. 54, No. 1, pp. 77-83).
Cerit, K., Keskin, S. T., & Ekici, D. (2018). Development of Instrument of Bullying Behaviors in Nursing Education based on Structured Equation Modeling. Asian Nursing Research , 12 (4), 245–250. doi: 10.1016/j.anr.2018.07.002
Llor-Esteban, B., Sánchez-Muñoz, M., Ruiz-Hernández, J. A., & Jiménez-Barbero, J. A. (2017). User violence towards nursing professionals in mental health services and emergency units. The European Journal of Psychology Applied to Legal Context , 9 (1), 33–40. doi: 10.1016/j.ejpal.2016.06.002
Wolf, L. A., Perhats, C., Clark, P. R., Moon, M. D., & Zavotsky, K. E. (2018). Workplace bullying in emergency nursing: Development of a grounded theory using situational analysis. International Emergency Nursing , 39 , 33–39. doi: 10.1016/j.ienj.2017.09.002
