Prof. (Mrs.) Karesh Prasad Principal People’s College of Nursing & R. C . Bhopal (M.P)

1. Prof. (Mrs.) Karesh Prasad Principal People’s College of Nursing & R. C. Bhopal (M.P)

3. DARK SIDE OF NURSING VIOLENCE IN WORKPLACE

4. INTRODUCTION • Half our waking hours are spent in the workplace. Hence the workplace environment is very important. • Violence & hostility is on increase in our day to day life. People burst into volatile actions on petty issues. • Violence has become part & parcel of our mechanized & competitive world. • Violence in workplace is a societal problem and a global issue.

5. The newspaper & magazines are full of instances highlighting increasing crime against women. • Weather you blame the T/V, media or downfall of moral values in the society the women has to face the wrath. Take the Eg of Indira Gandhi, & Benazir Bhutto they too became victims of violence in their work place and laid their lives for the nation.

6. Florence Nightingale would have been shocked seeing the pathetic state of nurses who are continuously faced with violence in workplace. • How can one forget Aruna Shan Baugh a nurse in KEM Hospital Mumbai, who was raped & crippled by a hospital staff? • Nurses are round the clock with patients hence they are the first ones to face the wrath of patients & relatives.

7. Violence in nursing is a matter of great concern for health care provider. Violent actions often seen are “Young psychiatric patient who hallucinates & begin to bite, scratch & kick whoever walks up to them “ “Serious patient’s family/relative in waiting room demands information & storms into treatment area pushing nurses & others staff aside.” “A drunken patient who wants to fight his way out of hospital punching & spiting on everyone that gets in his way”

8. We see these scenarios as part of the job. As per Bureau of labor statistics (2001) all occupations are exposed to violent crime (12-6 per 1000 workers) but personnel in the health & social service sector are exposed to greater violence ( Mental Health professional 6 of .2, Nurse 21.9 & physician 16.2 per 1000 workers). • The incident may be much higher as many incidences go unreported as the employer/employees save their negative image.

9. The National Safety Council believes that safety in the workplace is the responsibility of both the employer and the employee. • Threats to safety in the workplace are from exposure to potential violence from. • Violence from patients. • Violence from other staff members. • Violence from nursing staff. • Violence from relatives/visitors. • Lethal, chemical, injections etc.

10. These acts may be from External parties like uncivilized/robbers/self styled majnus. Internal parties like patients, relatives other professional members. • Work Place Violence leads to Low worker morale, high job stress, high turnover Low trust between management & co worker.

11. According to American Nurses Association “Abuse & harassment of nurses in professional association & in all work environments in whom nurses practice, including abuse, & harassment, based on age, color creed, durability, gender, health states, life style nationality, race religion or sexual orientation shall not be tolerated ”

12. STATEMENT OF THE PROBLEM • A study to assess work related violence faced by nurses working in selected hospital of Bhopal in Madhya Pradesh.

13. OBJECTIVES • To assess the violence faced by nurses in their work. • To identify the areas facing maximum violence in workplace. • To assess the various methods used to tackle violence by nurses. • To suggest remedial measures to overcome workplace violence

14. Study Population • The study population consisted of nurses who were presently working in two selected hospitals in Bhopal. Systemic Random sampling was done. So every 10 nurses were selected out of total 500 nurses working in two selected hospital of Bhopal. The total sample was 50.

15. Definition • Violence in the workplace include any activity (including traveling) associated with job or events that occurred in the work environment involving the intentional use of physical force or emotional abuse against an employee resulting in physical or emotional injury.

16. Physical Assault • when one is hit, slapped or kicked, pushed, grabbed, homicide use of weapons such as fire sexually assault or otherwise uses physical force intended to injury.

17. Threat: • Use of words gestures or action with the intention of frightening, or harming (physically or otherwise) body language, written threats.

18. Muggings: • Assaults conducted by surprise with intention to rob.

19. Sexual Harassment: • occurred when one experienced any type of unwelcome sexual behavior (words or actions) that created a hostile work environment.

20. Assault • It is an unlawful attempt, coupled with present ability to commit a violent injury on the person.

21. Verbal Abuse: • When another person yelled, engaged in name calling or used other words, intended to control or hurt.

22. Bullying • Any willful threat to inflict injury on another person or any intentional display of force as would give the victim reason to fear or expect immediate bodily harm. Bullying happens when someone hurts or scares another person being bullied has a hard time defending himself/herself .This happens getting certain people to gang on others, teasing people in a mean way.

23. Lateral or Horizontal Violence • This involves interpersonal conflict, harassment, harsh criticism, sabotage & abuse among nurses.

24. Data Collection • After obtaining formal administrative approval data was collected from 50 staff nurses working in Bhopal Memorial Hospital and Research Centre and People’s Hospital and Research Centre by Probability Sampling Technique. Data was collected by giving self-introduction and establishment of rapport with the subject. The subjects were interviewed personally by investigator by using structured interview schedule.

25. Data Analyses • Plan for data analysis was chalked out by employing descriptive statistics. The frequency and percentage computation was done.

26. Table No. 1. Age wise distribution N=50 Table No. 1 describe age wise distribution. It shows that majority 31 (62%) of the Nurses belong to 25 to 30 age group. Where as 14 (28%) were les then 25 years of age. Only 4 (8%) Nurses were more than 35 years of age.

27. Age wise Population of India(Source: Employment News 22-28 Dec 2007)

28. Table No. 2 Sex wise Distribution N=50 Table No. 2 describe sex wise distribution. It shows that majority 40 (80%) of the Nurses were female Where as 10 (20%) were male.

29. Table No. 3 Marital status wise distribution N=50 • Table No. 3 describes marital status wise distribution of the Nurses majority 33 (66 %) of the Nurses were single. This shows that Nurses are getting married late. The no. of married nurses was 17 (34 %).

30. Table No. 4 Income wise distribution N=50 • Table No. 4 describes Income wise distribution of the Nurses. Majority 23 (46 %) were earning up to Rs. 7000/- . Non of the nurses where getting more than Rs. 7000/-. This indicate that nurses are paid low.

31. Table No. 5 Place of residence N=50 • Table No. 5 describes place of residence wise distribution of the Nurses. Majority 31 (62 %) were residing with in the campus where as 13 (26 %) of the nurses were staying 6-8 Km away from their place of work

32. Table No. 6 Native place wise distribution N=50 Table No. 6 describes native place wise distribution of the Nurses. Majority 14 (28 %) nurses belonged to Madhya Pradesh where as 12 (24 %) of the Nurses belonged to Kerala. This indicate that female from Madhya Pradesh are still not coming forward for nursing.

33. Table No 7 Duration of Employment N=50 Table No. 7 describes duration of employment wise distribution of the Nurses. Majority 48(96 %) of the Nurses were employed for les than 5 years

34. Table No. 8 Place of work N=50 Table No. 8 describes place of work wise distribution of the Nurses. Majority 40 (80 %) of the nurses were working in private hospitals.

35. Table No. 9 Education Qualification N=50 Table No. 9 describes educational qualification wise distribution of the Nurses. Majority 46 (92 %) of the nurses basic qualification was 10+2. which is the entry qualification required in nursing.

36. Table No.10 Professional Qualification N=50 Table No. 10 describes professional qualification wise distribution of the Nurses. Majority 34 (68 %) of the nurses were having GNM qualification. Their were 15 (30%) nurses who were B. Sc. (N).

37. Table No 11 Have you faced violence during last one year of your service? N=50 Table No.11 describes if they faced violence during their services. Majority 49 (98 %) of the nurses accepted that they faced some form of violence during their service.

38. Table No 12 Area of work where they faced violence. N=50 Table No.12 describes if they faced violence during their services. Majority 24 (48 %) agreed that they faced violence while working in ICU. Where as 12 (24 %) faced violence while working other then ICU & 10 (20 %) agreed that they faced violence while they were working in emergency.

39. Table No. 13 Violence directed towards. N=50 Table No. 13 describes that majority 27 (54 %) the violence was directed towards staff. Only 8 (16 %) the violence was directed towards patients and others

40. Table No. 14 Who was the Assailant ? N=50 Table No. 14 describes that majority 27 (54 %) visitors were the assailants where as 13 (26 %) patients were assailants.

41. Table No. 15 What was the no. of Assailant ? N=50 Table No.15 describes that majority 25 (50 %) of the visitors who were single were the assailants. Assailant 21 (42 %) were in group.

42. Table No. 16 what was the predisposing factor in the violent attack? N=50 • Table No.16 describes that majority 14 (28 %) were violent due to dissatisfaction to care in parted. 12 (24 %) became violent due to long waiting hours. Where as 10 (20 %) became violent due to reaction after death.

43. Table No. 17 what was the violent incident? N=50 Table No.17 describes that majority 42 (84 %) stated that they faced verbal abuse where as 8 (16 %) informed that they were physical abused.

44. Table No. 18 what was the extent of injury caused to you? N=50 • Table No.18 describes that majority 44 (88 %) were caused injury other than face and bruises.

45. Table No. 19 How was the assailant disposed ? N=50 • Table No.19 describes that majority 23 (46 %) that assailants stayed in premises. Where as 15 (30 %) assailants left the side on their own.

46. Table No. 20 How was the incident terminated? N=50 • Table No.20 describes that majority 25 (50 %) that the violent incident was diffused at its own where as 18 (36 %) said that the incident was terminated through means other than police or arrest.

47. Table No. 21 what help was sought by you to tackle the violent incident? N=50 • Table No.21 describes that majority 18 (36 %) informed that they called the nursing supervisor where as 14 (28 %) called hospital administrator and 12 (24 %) called the security guard.

48. Table No. 22 what action was taken by hospital administration? N=50 • Table No.22 describes that majority 32 (64 %) complaint was lodged where as 15 (30 %) informed that assailant was handed over to security.

49. Improving the working condition • Education and training. • Reducing Risk. • Increasing protection in workplace. • Rules regulation and policies.

50. Understanding Common causes of violence in workplace • Death of patient • Non availability of expected care. • Concern & stream of family member due to patient’s critical condition. • Family member anger related to hospital policy. • Long waiting time is clinically. • Lack of adequate security personnel.