Dealing with violence and aggression is an area where health professionals often feel uncertain. Standing at the interface between medicine, psychiatry and law, the best actions may not be clear, and guidelines neither consistently applicable nor explicit. Psychiatric nurses run a high risk of being exposed to aggression- They experience aggression from patients as well as fellow colleagues. Aggression in the work environment has an overt negative psychological effect on the nurse.
In a new study, researchers from the Department of Nursing Sciences within the Faculty of Health Sciences at the University of Johannesburg (UJ), found that in a working environment with dysfunctional nurse-to-nurse relationships, stress and aggression in the work environment compromise factors such as low productivity owing to conflicts, recruitment and retention challenges, burnout, absenteeism, litigation and rapid staff turnover.
To assess the extent of this contextual study, the population for this research consisted of the psychiatric nursing staff registered with the South African Nursing Council and were employed in an academic psychiatric hospital in Johannesburg. The researchers utilised purposive sampling. The criteria for sampling were as follows: participants were professional nurses who were working in an academic psychiatric hospital where the research was conducted, and who had been working there uninterruptedly for a minimum period of 24 months. The psychiatric nurses needed experience in an academic psychiatric hospital in order to give a valid account of their experiences and to be familiar with the environment in which they work. They had to be able to speak English or Afrikaans.
The UJ team found that the psychiatric nurses experienced aggression as subtle, passive and harmful in a verbal and non-verbal manner. The psychiatric nurses reported that different types of aggression were present in their work environment, namely verbal and non-verbal aggression. Verbal aggression was visible in the forms of gossiping, backbiting, snide remarks made to each other, the abuse of language barriers and cultural differences. The nurses denied direct or physical aggression in their work environment and reported that only in selective cases they had the urge to react at a physical level. All the psychiatric nurses emphasised the experience of non-verbal aggression in the work environment. Non-verbal aggression manifested in the psychiatric nurses’ reports of feeling ignored and judged by their colleagues.
Prof Marie Poggenpoel and her co-authors also observed that that education and socialisation at different levels exhibit different values and perceptions of professional identity. This had been observed to create conflict amongst nurses when they enter the workforce. In multicultural teams, increased levels of relationship conflict were found. The diversity was related to both process and delegation conflict and affected the communication outcomes, said the researchers.
The importance and effect of violence and aggression in day-to-day living should not be underestimated. It is assumed that it could have severely harmful psychological consequences in the long term and that it can thus affect the psychiatric nurses’ self-esteem, social status and happiness. The importance of nursing staff’s roles and attitudes in the interaction with the psychiatric environment which should ultimately strive to create a therapeutic milieu. This implies that the psychiatric nurse’s interpersonal skills play an extremely important role in the creation of such an ideal milieu in the work environment.
While there is evidence that the work pertaining to nursing was often stressful and that stress had been identified as one of the reasons for nurses failing to function at an optimum level of effectiveness. Stress and work environment conflict had a significant effect on the nurses. As a result, they might experience physiological, psychological and social challenges; thus affecting the individual nurse’s self-esteem and self-confidence that could lead to burnout, said the researchers.
In general hospital settings, aggression is commonly assumed to be most prevalent in emergency departments, where dealing with aggression is a significant concern. But the incident reports indicate that events are numerically more common on medical, geriatric and psychiatric wards. “It is clear that attention should be given to create opportunities for psychiatric nurses to master the management of experienced aggression from colleagues,” explained Prof Poggenpoel.
Professor Marie Poggenpoel has been since 1989 a tenured professor in Psychiatric Nursing Science at the University Of Johannesburg and is an expert regarding qualitative as well as quantitative research methodologies.
She had published more than 185 articles in international and national journals. She was the supervisor/ co-supervisor of more than 142 doctorates and 182 master’s candidates.
In South Africa she is rated as established researcher by the National Research Foundation (NRF). She has received several awards for excellence in research, the most recent award being the “International Nurse Researcher Hall of Fame” awarded by Sigma Theta tau International ( STTI) in July 2013 in Prague and the “Women in Science Award” in May 2014 in South Africa.