Researchers from the Faculty of Nursing at the U of A drew on data they collected for an earlier study. They surveyed more than 9000 nurses in Alberta and British Columbia, asking if they had experienced any of the five types of violence—physical assault, threat of assault, emotional abuse, verbal sexual harassment, sexual assault—within the past five shifts worked. They were also asked to indicate the sources of violence: patient, family or visitor, physician or nursing co-worker.
One in five nurses experienced more than one type of violence in a five-shift period. While patients still represented the largest proportion of perpetrators overall, hospital co-workers were responsible for 56.7 per cent of all emotional abuse and 53.6 per cent of all verbal sexual harassment in the critical care setting. Nurses tended not to report violent episodes in general, but were even less likely to report violence if a co-worker was the abuser.
In this latest study, published in the March issue of the journal Health Policy, the researchers tried to determine why this behaviour continues in hospital settings. One theory that might explain the violence is the “Broken Windows” theory of criminal behaviour, said Katie Rickers, the lead author on the paper. “There is nothing else out there in the literature on how to treat violence in health-care organizations so we turned to a theory in criminal behaviour,” she said.
In the Broken Windows theory, tolerating lesser criminal acts—such as vandalism—in a community creates an environment where more crime takes place. Petty crime in a neighbourhood is a signal of social disorder and that criminals sense little resistance to their illicit activities. The same explanation can be applied to hospital settings, said Rickers. “Part of the problem is that if co-workers are abusing each other and that is seen as okay, patients are more likely to commit violent acts.”
Taking a Broken Windows approach to violence prevention would require an immediate visible response to all incidents, no matter how serious. Considering the current difficulty in retaining health professionals and the link between violence in the workplace and lowered job satisfaction, investigating the impact of workplace violence in hospitals is even more timely.
This research is funded by the Alberta Foundation for Medical Research.
The U of A in Edmonton, Alberta is one of Canada's premier teaching and research universities serving more than 33,000 students with 6,000 faculty and staff. It continues to lead the country with the most 3M Teaching Fellows, Canada's only national award recognizing teaching excellence.
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Health Policy