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Covert Violence in Nursing: a Western Australian Experience

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Covert Violence in Nursing: a Western Australian Experience Edith Cowan University Research Online Theses: Doctorates and Masters Theses 2012 Covert violence in nursing: A Western Australian experience Susette Bakker Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses Part of the Nursing Commons Recommended Citation Bakker, S. (2012). Covert violence in nursing: A Western Australian experience. https://ro.ecu.edu.au/ theses/455 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses/455 Edith Cowan University Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorize you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: Copyright owners are entitled to take legal action against persons who infringe their copyright. A reproduction of material that is protected by copyright may be a copyright infringement. Where the reproduction of such material is done without attribution of authorship, with false attribution of authorship or the authorship is treated in a derogatory manner, this may be a breach of the author’s moral rights contained in Part IX of the Copyright Act 1968 (Cth). Courts have the power to impose a wide range of civil and criminal sanctions for infringement of copyright, infringement of moral rights and other offences under the Copyright Act 1968 (Cth). Higher penalties may apply, and higher damages may be awarded, for offences and infringements involving the conversion of material into digital or electronic form. PROJECT TITLE Covert Violence in Nursing – A Western Australian Experience STUDENT Susette Bakker 866124 UNIVERSITY Edith Cowan University DEGREE Doctor of Philosophy (Public Health) PRINCIPAL SUPERVISOR Dr Janis Jansz DATE OF SUBMISSION 31st January 2012 i USE OF THESIS The Use of Thesis statement is not included in this version of the thesis. ACKNOWLEDGEMENTS I would like to acknowledge the following people without whom this thesis would not have been completed: Dr Janis Jansz for her encouragement and perseverance. Dr Milos Nedved for his valued review and encouragement. All nurses who contributed to the data collection. Thank you for your trust and openness. My husband, Pieter, who proved to be multi-skilled, good-natured and thoroughly reliable. iii DECLARATION I certify that this thesis does not, to the best of my knowledge and belief: (i) incorporate, without acknowledgement, any materials previously submitted for a degree or a diploma in any institution of higher education; (ii) contain any material previously published or written by another person except where due reference is made in the text; or (iii) contain any defamatory material. iv ABSTRACT Covert violence in the workplace has been extensively theorized amongst social scientists as having negative effects on the worker’s self esteem, job satisfaction and stress, resulting in increased absenteeism and a reduction in productivity, and yet it continues to fester in nursing. The purpose of this research was twofold. The first was to answer the question, ‘What are the characteristics of covert violence experienced by Western Australian nurses?’ and through the description of Western Australian nurses’ experience of covert violence and describe the characteristics related to this to form a definition of covert violence. The second question was ‘What are the causes of covert violence experienced by Western Australian nurses? This study explored nurses’ experiences of covert violence using an interpretive phenomenological approach as described by van Manen (1997). A literature review was conducted to establish the findings of studies in relation to covert violence in other countries and to compare similar works in Australia. Using literature review findings, interview questions were designed to identify episodes of covert violence amongst nurses, the background to the reported events and a comment by the participants as to how these episodes were dealt with. A proposed model of the causes of covert violence in nursing was developed from the literature review to be tested in relation to the research findings. Research participants were all Registered Nurses with the Nurses’ Board of Western Australia who were asked to identify and discuss their experiences of covert violence in their workplaces. The data collected was analysed using pattern matching for qualitative evaluation. v Results obtained from the data analysis identified the most important factor leading to covert violence was the juxtaposition of power and powerlessness and how it was influenced by community expectations of healthcare, staffing and client characteristics, infra-staff issues and management systems. Based on the research findings a revised model of causes of covert violence was developed to identify how power and powerlessness affect the outcomes of patient care, staff morale and the ultimate retention of staff in the health service in particular and in the profession generally. To record the incidences of covert violence and how they can be dealt with, a risk action plan and a model of obligations to prevent covert violence in nursing was developed that would not only serve its purpose in the nursing profession. From these questions it was possible to develop a Risk Control Action Plan that can be applied in response to reports of covert violence and to prevent covert violence in the nursing workplace, and can be adapted to address a similar situation in any other workplace. The tools developed include ways of reducing patient stress, methods of improving staff relationships, and management tools for issues that need to be addressed by nurses and administrators. Recommendations for further research to extend this study and to test the covert violence prevention tools developed as a result of this research are made. It is anticipated that use of the revised model of covert violence in nursing, definition of covert violence and tools developed as a result of the research findings will minimise incidences of covert violence, resulting in greater job safety and satisfaction for nurses, a reduction in staff absenteeism due to job stress, and an improvement in nursing retention and productivity. vi CONTENTS Title Page ........................................................................................... i Copyright and Access ........................................................................ii Acknowledgements ...........................................................................iii Declaration ........................................................................................iv Abstract ..............................................................................................v Contents ............................................................................................vii 1.0 INTRODUCTION 1.1. Introduction .................................................................................1 1.2. Background of the study............................................................. 1 1.3. Previous research .......................................................................2 1.4. Purpose .......................................................................................6 1.5. Definition of terms .......................................................................6 1.6. Research questions .................................................................8 1.7. Outline of the thesis ......................................................................8 1.8. Summary ...................................................................................10 2.0. LITERATURE REVIEW 2.1. Introduction ...............................................................................11 2.2. Method description for literature review ....................................11 2.3. Violence in the workplace ..........................................................12 2.3.1. Types of violence in the workplace ..............................13 2.3.2. Costs of workplace violence to the organisation ...........15 2.4. Causes of workplace violence .....................................................16 2.5. Covert violence in nursing .........................................................20 2.5.1. Nursing as a culture .....................................................21 2.5.2. Causes of covert violence in a nursing setting ...........25 2.5.3. Client characteristics.................................................. ..27 2.5.4. Causes of infra-staff violence ......................................27 vii 2.6. Costs of covert violence ...........................................................29 2.6.1. Societal costs .............................................................29 2.6.2. Staff costs ...................................................................29 2..6.3. Organisational costs ..................................................29 2.7. Reasons for underreporting ......................................................30 2.8. International literature review ...................................................32 2.8.1. Introduction .................................................................32 2.8.2. Australia and New Zealand .........................................32 2.8.3. Canada .......................................................................40 2.8.4. United States of America (U.S.A.)..............................43 2.8.5. United Kingdom
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