Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Perceptions of Nurses’ Abilities to Provide Safe Care in Unhealthy Work Environments Jacqueline Flannery Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Jacqueline Flannery has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Mary Martin, Committee Chairperson, Nursing Faculty Dr. Anna Valdez, Committee Member, Nursing Faculty Dr. Maria Ojeda, University Reviewer, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Perceptions of Nurses’ Abilities to Provide Safe Care in Unhealthy Work Environments by Jacqueline Flannery MSN, Jacksonville University, 2014 BSN, Jacksonville University, 2013 AAS Kingsborough Community College, 2001 BA, New York University, 1998 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Walden University Walden University May 2020 Abstract As many as 90% of nurses report working in an environment where their peers engage in passively and overtly violent activities against other nurses. Working in such an environment is unhealthy and has consequences for the career trajectory of nursing. There is a lack of literature available that specifically addresses nurses’ perceptions of their abilities to provide safe patient care in unhealthy work environments. The purpose of this phenomenological study was to explore the lived experiences of nurses who have experienced lateral violence and their perceptions of their ability to provide safe care. Husserl’s philosophy of phenomenology was used as the conceptual framework and Freire’s theory of pedagogical oppression and empowerment was used as the theoretical framework of this study. Semistructured telephone interviews were conducted with 13 registered nurses who experienced lateral violence. I then analyzed verbatim transcriptions of the interviews using manual coding. Categorization of data into 5 themes was accomplished utilizing interpretative phenomenological analysis. The themes included lateral violence, responses to lateral violence, oppressive group behavior, unsafe care, and coping. Recommendations based on this research included acknowledging that lateral violence is often present in the workplace, taking a clear stand against it, supporting the victim by directly confronting the perpetrator, and providing support services to the victim. Results from this study can be used to promote positive social change by informing nurses of the dangers of lateral violence and by encouraging a change of culture in work environments where nurses support each other. In doing so, nurses may be better equipped to address patient needs and provide safe care. Perceptions of Nurses’ Abilities to Provide Safe Care in Unhealthy Work Environments by Jacqueline Flannery MSN, Jacksonville University, 2014 BSN, Jacksonville University, 2013 AAS, Kingsborough Community College, 2001 BA, New York University, 1998 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Walden University Walden University May 2020 Dedication This study is dedicated to all nurses who entered the nursing profession with the intention of caring and advocating for patients, but were forced to endure the abuse of lateral violence. Thank you for your service and commitment to patient safety. Acknowledgments I would like to thank my husband, Brian, and my children, Caitlin, Meagan, Kristen, and Brynn for their patience and support while I was on this journey. Your sacrifices and understanding allowed me to persevere, even when times were tough. I would like to acknowledge the immense amount of support that I received from Dr. Mary Martin. Whether it was a phone call or email, you were always able to provide the encouragement that I needed. Thank you so much for all of your insight. I would like to thank Dr. Anna Valdez, who provided me with so much useful advice on performing qualitative studies and data interpretation. Thank you taking the time to speak with me, especially when data collection was difficult. I would also like to thank Dr. Maria Ojeda for providing valuable input into the quality of this work. I will forever be grateful to all of you. Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................3 Problem Statement .........................................................................................................8 Purpose of the Study ....................................................................................................11 Research Question .......................................................................................................12 Conceptual Framework of the Study ...........................................................................12 Theoretical Framework of the Study ...........................................................................13 Nature of Study ............................................................................................................13 Definitions....................................................................................................................16 Assumptions .................................................................................................................17 Scope and Delimitations ..............................................................................................17 Limitations ...................................................................................................................18 Significance..................................................................................................................19 Summary ......................................................................................................................21 Chapter 2: Literature Review .............................................................................................22 Introduction ..................................................................................................................22 Literature Search Strategy ............................................................................................25 Conceptual Framework ................................................................................................25 i Husserl’s Phenomenology .................................................................................... 25 Theoretical Framework ................................................................................................26 Freire’s Theory of Pedagogical Oppression and Empowerment .......................... 26 Literature Review.........................................................................................................31 Healthy Work Environments ................................................................................ 31 History of Lateral Violence .................................................................................. 33 Contributing Factors ............................................................................................. 38 Consequences of Lateral Violence ........................................................................ 41 Strategies to Prevent Lateral Violence .................................................................. 43 Summary ......................................................................................................................55 Chapter 3: Research Method ..............................................................................................58 Introduction ..................................................................................................................58 Research Design and Rationale ...................................................................................58 Role of the Researcher .................................................................................................59 Methodology ................................................................................................................61 Participants Selection Logic ................................................................................. 62 Instrumentation ....................................................................................................