Describing Perceptions of Horizontal Violence in a Military Treatment Facility

Describing Perceptions of Horizontal Violence in a Military Treatment Facility

Bibliography

Name: Francisco Aguirre

Rank:

Presenter/Poster: Podium

Year: 2014

Abstract

Introduction: Horizontal violence (HV) behaviors within the nursing work environment can lead to negative psychological and physical outcomes for nurses including; decreased job satisfaction, intention to leave the job, and poor patient outcomes. The occurrence of HV within the hierarchical military health care work environment as well as effective interventions to alleviate any HV behaviors, however, have not been established.Purpose: The purpose of this study was to explore the perceived experience of HV by nursing staff and to determine if HV education changes the perceived experience of HV by nursing staff in a Military Treatment Facility.

The specific aims of the study were to 1) determine the reliability and validity of the Horizontal Violence Workload Inventory-Modified (HVWI-M) in a military nursing environment, 2) describe the perceived experience of HV as measured by the HVWI-M, 3) measure the relationship between HV and job satisfaction and intent to leave, and 4) determine if HV education changes the perceived experience of HV.

Population: A convenience sample consisting of the entire nursing staff at LRMC (N=790), including nurse supervisors, managers, nurses, nursing assistant and medics, both inpatient and outpatient, were invited to participate in the survey and the educational intervention.Design: This exploratory prospective descriptive pilot study used a one group before-after design to describe HV and to explore the effectiveness of an educational intervention. The research team adapted the Horizontal Violence Workplace Inventory to ensure face and content validity as well as military relevance. Data regarding perceived experience and/or witness of HV was collected via this 52-item anonymous electronic survey over one month (HVWI-M). After the survey closed, an educational intervention designed by the research team based on evidence was conducted for 2 months to increase HV awareness and to train staff using cognitive rehearsal techniques. The HV survey was redistributed 5 months after the close of the first survey (pending closure on 16 July 2014).Data Analysis: Data analysis includes a) reliability and validity analysis of the HVWI-M, b) descriptive statistics to describe the perceived experience of HV (covert, overt, personal effects, and perpetrators), c) tests for dependence using demographic, job satisfaction, and intent to leave items, and d) statistical modeling to determine differences in HV before and after the intervention.

Theoretical Framework: HV within nursing has been hypothesized as an outcome of oppression of nursing both as a predominantly female and a caring profession. It has been proposed that physicians and administrators hold power and control positions within hospitals. In contrast, nurses carry a large workload demand in terms of responsibility for direct patient care with less autonomy, power or control. The oppression experienced by nurses within a hierarchical health care system can lead to behaviors that intimidate or demean their peers and subordinates as an outlet for the stress - horizontal violence.

Preliminary Results: Of the 142 nursing staff who responded to the initial HV survey, the majority of respondents were registered nurses (n=93) and medics (n=22) in their current position for 1-2 years (n=42). The nursing staff reported experiencing HV behaviors an average of once to a few times over the past 3 months—both overt (M=2.8, SD=1.2) and covert (M=2.5, SD=1.3). They felt personally affected (M=2.1, SD=1.2) by these behaviors an average of once to a few times as well. The respondents identified staff nurses and supervisors as the most frequent perpetrators of HV, observing them exhibiting these behaviors a few times to monthly over the past 3 months. The HVWI-M had a Crohnbach’s alpha of 0.96. Job satisfaction was 2.3 (SD=0.1) on a scale of 1 (very satisfied) to 4 (very dissatisfied). The respondents reported intent to leave their current job (M=2.3, SD=1.2) and intent to leave DoD employment (M=2.6, SD=1.2) between likely (2) and unlikely (3) on a 4 point scale. The final data analysis for all aims will be completed after closure of the post-survey on 16 July 2014.

Conclusions: The results of this pilot study provided evidence that HV does exist within an MTF, will indicate if there is a relationship between HV behaviors and job satisfaction or intent to leave, and may have identified a method to effectively and professionally address instances of experienced or witnessed HV.Implications: The nursing implications from the preliminary results suggest that even within military nursing with hierarchical rank structure, perceptions of HV exist. Therefore, steps must be taken to educate nursing staff on HV, to include their own role as potential perpetrators and in acting to alleviate it. Recommendations: The recommendations will be based on the final results. It is anticipated that the recommendation will be for face-to-face training, using cognitive rehearsal techniques (such as those identified in TeamSTEPPS) to assist in decreasing the incidence of HV within MTFs.

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IRB Approval: This protocol received Institutional Review Board approval through Medical Research and Material Command M-10354 on 11 Oct 2013.Research Team Members: 1LT Caitlin Fuhrman, LTC Susan Hopkinson, Maj Michelle Langdon, 1LT Paul Merrill, COL Lori Trego, 1LT Amanda VanDeWalle.CONTENT DISCLAIMER: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, nor the U.S. Government.