RMIT University MC258 Assessment 2: Occupational Violence Report

This report investigates the issue of occupational violence (OV) among mental health nurses, a significant concern in healthcare settings, particularly in Australia. It explores the increased vulnerability of nurses due to high patient contact and the resulting psychological impacts, including post-traumatic stress. The report analyzes contributing factors such as poor organizational justice and inadequate teamwork, which exacerbate patient-staff interactions. It emphasizes the role of mental health nurse managers in mitigating OV through strategies like workforce adjustments and improved training. The methodology involves a systematic review of literature published within the last 10 years, examining the physiological and psychological effects of OV on mental health nurses and the nurse manager's role in reducing its incidence. The report highlights the context of the problem, including the stakeholders involved (nurses, patients, and managers), contributing factors (extended shifts, workforce shortages), and the specific issues within the Australian mental healthcare environment, such as verbal and physical aggression from patients, family members, and even colleagues. The report also discusses the methodology using a qualitative study with a systematic review of literature, which helps in generating evidence-based practice guidelines and decision-making for nurse managers. The exemplar used is a study that reviews the aftermath of workplace violence (WPV) among healthcare professionals and the after effects like physical complications, psychological stress and medication errors.

Running head: ASSESSMENT 2
Assessment 2
Name of the Student
Name of the University
Author Note

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ASSESSMENT 2
Introduction
Occupational violence (OV) among the mental health nurses under the healthcare
settings is a well-known issue. The high level of nurse to patient contact increases the
vulnerability of encountering this occupational hazard (Hvidhjelm et al., 2016). Nowrouzi
and Huynh (2016) however, highlighted a different perspective altogether. Pekurinen et al.
(2017) stated that the nurses who stay more time with the healthcare service users are at
lower risk in comparison to the nurses who spent less time with the patient in developing OV.
The victims of the OV like the nurses tend to become victim of post-traumatic stress response
that hampers the overall mental health of the nursing professionals (Itzhaki et al., 2018).
Ramacciati, Bambi and Rasero (2018) stated that the nurse perception about the poor
organizational justice and lack of proper team work negatively affect the patient to staff and
staff to staff interaction that increase severity of OV. The consequences of the OV or the
workplace violence (WPV) increase the overall service costs and at the same time decrease
the overall standards of care.
The purpose of this assignment is to elucidate the physiological and psychological
impact of the OV over the mental healthcare nursing professionals and to elucidate the role
mental health nurse manager in order to decrease the impact of the occupational violence.
The out of the context in which the assessment has occurred is: conduction of this assessment
will help to improve the overall quality of the under the mental health nursing practice. Niu et
al. (2019) are of the opinion that the mental health nursing professionals who become victim
of the OV exhibit reduced quality of care along with fall in the overall work morale and this
increases their turnover rate. Thus elucidation of the mental and physical impact of the OV
over the mental health (MH) nurses and the role of the MH nurses in order to reduce the
occurrence rate of the OV will help to improve the overall quality of care.

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ASSESSMENT 2
The assignment will initiate with conducting a systematic review of the articles that
coincide with the scope of the research topic and were published within the last 10 years
followed by analysis of the mental health nursing practice that will help to bring the change.
DefinitionsOccupational Violence: Occupational violence occurs when someone is abused,
assaulted, threatened in relation to their work. OV can be both physical and verbal. The
majority of the OV occurring under the mental healthcare practices are perpetrated either by
the patients or their family members. Under disaster and conflict situations, the healthcare
workers become victim of the collective or political violence (WHO, 2019).
Mental health nurse: Mental health services in Australia provide help to 4.2 million
patients with mental-health complications. The duty of the mental health nurse provides
services to the people suffering from the mental health complications like depression,
anxiety, stress, post-traumatic disorder, schizophrenia, dementia and Alzheimer. Nearly 1 out
of 15 nurses including the registered and the enrolled nurses in Australia are working as the
mental health nurses (Australian Institute of Health and Welfare [AIHW], 2019).
Nurse Manager: Nurse Managers are the senior nursing professionals who are
responsible for creating safe and healthy work environment while improving the overall
quality of care for the patients. Their role is influential towards creating a professional work
environment and at the same time fostering a culturally competent work environment where
the inter-disciplinary team members provide a significant contribution in order to improve the
patient outcome (Warshawsky & Havens, 2014).
According to the study conducted by Tonso et al. (2016) under the Australian
perspective, OV in the mental health setting is an alarming issue and there is limited

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ASSESSMENT 2
knowledge about the nature, frequency and the other health consequences of the staffs who
are exposed to the workplace violence under the Australian healthcare settings. In order to
address this gap, Tonso et al. (2016) conducted a study over the mental health nursing
professionals in Victoria Australia with cross-sectional exploratory descriptive type study
design. A total of 1600 mental health care nurses were included in the study. The analysis of
the results reported that mental health nurses are vulnerable to become victim of OV in the
form of physical violence, verbal aggression and bullying. The members of the victims of the
OV experience psychological problems. The nature, severity and the overall health impact of
the OV represents a significant safety concerns for the mental health nursing professionals
and thus nurse managers must come forward with tailored strategies for prevention of the
OV.
Background and Context to Health Research ProjectWho are involved: The main stakeholders of this research project are the mental
healthcare nurses who are the victims of the OV, the patients and the family members are
promote OV over the mental health nurses. The final stakeholder of this project is mental
healthcare nurse manager who controls and co-ordinates the work flow in the mental health
ward. When/where did this occur: Under the mental health ward, in-patient hospital
settings.
Contributing factors leading to health problem: Extended shift timings, lack of
proper mental health nursing workforce, lack of skills of the mental health nurses and poor
management of the overall work execution under the mental healthcare settings

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Solutions: Decrease in the OV by increasing the nursing workforce or reduction
under the extended shift timings of the nursing professionals (O’Rourke, Wrigley &
Hammond, 2018). However, the application of these interventions has failed to fetch any
significant results for reducing the OV. The reason behind this is there are 4.2 million people
receive mental health services in Australia during the tenure of 2017 to 2018 (AIHW, 2019).
The extended nursing workforce is still limited under these healthcare-settings with over-
flowing patient strength. Thus the mental health administrative department of Australia is
unable to reduce the work stress over the mental health nurses and thus they are forced to
work under the extended shift timings and are required to handle gamut mental healthcare
service users and this increase the vulnerability of getting victim of OV (AIHW, 2019)
How this problem is occurring in the mental health environment in Australia:
The mental healthcare nurses who are working under the Australian healthcare settings
become victims of the verbal and physical violence. According to the news report published
by ABC news Australia (2019), the level of verbal violence against the mental healthcare
nurses are higher in comparison to the healthcare settings of other developed countries. The
verbal violence at times converts into physical violence and thereby increasing the
occupational hazard. The mental health nursing professionals working under the rural
healthcare settings of Australia are prone to get exposed to the occupational violence. The
lack of deployment of the mental health nurse managers in the community healthcare
settings, increase the severity of the OV further (Thompson, 2019). Another study conducted
under the Australian mental healthcare settings also reported that the verbal violence is the
most common form of violence for the mental health nurses in Australia leading to poor
healthcare outcome and increase in the rate of the nursing turnover (Konttila, Pesonen &
Kyngäs, 2018).

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ASSESSMENT 2
Issues specific to work environment: The verbal and physical aggression not only
come from the patients and their family members but also from the co-colleagues. This is
unique under the mental healthcare workplace settings of Australian healthcare (Konttila,
Pesonen & Kyngäs, 2018).
Summary of the Existing Literature
Gillespie et al. (2010) conducted a study in order to described the risk factors and the
protective strategies that are associated with the WPV over the healthcare professionals by
the patients and visitors. The characteristics of the healthcare professionals that increase the
workplace risk include the gender, age, marital status and the years of experience of the
students and any previous exposure of the violence training under the healthcare settings.
Environmental risk factors for workplace violence are security cameras and the time of the
duty hours. The protective strategies for fighting against the negative consequences include
practice of the self-defense, social support and restricting the interactions with the
perpetrators of violence. Lanctôt and Guay (2014) conducted a study in order to elucidate the
aftermath of the WPV under the healthcare settings. The results of the study reported that the
aftermath of the WPV include fear, disgust, surprise leading to increase turnover of the
healthcare professionals and decrease in the quality of care.
Methodology and Method
Rationale for the selection of systematic review as the main methodology
The main methodology that is used for the conduction of the research project is
qualitative study under the perspective of the systematic review of literature. The systematic
review of literature was selected for the conduction of this research because, The importance
of the systematic reviews in the nursing can provide an invaluable source of information in

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ASSESSMENT 2
order to encourage the evidence-based practice guidelines. The healthcare decisions for the
patients and for the development of the public health policies must be informed with the help
of the best research evidence. The practice of the evidence based nursing management
strategies deals with the integration of the available source f the best possible information
collected from the previously published journal articles with the help of the systematic
research (Gopalakrishnan & Ganeshkumar, 2013). Clarke (2011) are of the opinion that the
for the development of the policies in the nursing practice and to bring change in the overall
leadership traits among the nursing managers for improving the service delivery approach,
systematic review of the journal articles hold prime importance. The importance of the
systematic review in the nursing research can also be defined under the light of the study
conducted by (Clarke, 2011). Gopalakrishnan and Ganeshkumar (2013) are of the opinion
that the with the explosion of the gamut nursing literary articles, and limited amount of time
available to the nurse managers, review of the articles also play an important role in the
process of decision making and for the generation of the evidence-based practice guidelines.
The majority of the healthcare professionals working as the administrative head or the nurse
managers do not have time to review all the articles or the critically analyse them or to reach
them for obtaining evidences. Thus systematic reviews help them to get a detail a summative
overview of the research findings of more than one article and thus helping to save a lot of
time and at the same time help in the selection of the best possible interventions or the
practice guidelines. Systematic review also aims to identify, evaluate and to summarize the
research findings of all the relevant yet individuals studies over any particular health related
problems and thereby helping to make the evidence more accessible to the decision makers
(Gopalakrishnan & Ganeshkumar, 2013). Thus it can be said that in order to generate the
summative overview of the nursing strategies that can be used by the nurse managers for the
reduction of the OV, the conduction of the systematic review of articles will be important.

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ASSESSMENT 2
Exemplar used for the selection of the selection of the methods
The exemplars based on which the study design of this research project is being
selected include the systematic review conducted by Lanctôt and Guay (2014). The aim of
the study conducted by Lanctôt and Guay (2014) deals with studying the aftermath of the
WPV among the healthcare professionals. The study reviewed 68 articles that were published
within the last 10 years. The review of these articles helped to get a summative overview of
the aftermath of the WPV. The main factors that were evolved in the study include physical
complications, psychological stress, emotional turmoil, decreased quality of care, hamper in
the team based relationships, poor personal life and increase in the chances of the medication
error. The scope of the study though not directly related with the scope of the research
project and but overall scope of the study is associated with the one of the object of the
research. The analysis of this study helped in understanding that the conducting systematic
review helps to provide a summative overview of the factors associated with the nursing
practice, which is otherwise not possible by conducting a primary research under any
particular healthcare settings.
The methods used for conducting the systematic review
Eligibility criteria for the selection of the articles
Factors Inclusion Criteria Exclusion Criteria
Year of publication 2010 to 2019 (last 10 years) Published before 2010
Language English Language other than English
Type of Journal Article Peer-reviewed Non peer reviewed
Type of research Primary and Secondary research
including both qualitative and
quantitative research
News reports or case studies or
the grey publication like
government publication

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ASSESSMENT 2
The main databases that will be used for the search of the articles
 Cochrane
 CINHAL
 PubMed
 Medline
The keywords for database search
Boolean
Operator
Boolean
Operator
Keyword 1 Occupational
violence
OR Impact of
Occupational
violence
OR Work place
violence
Boolean Operator AND
Keyword 2 Mental
health nurse
OR Mental
health
nursing
professional
OR Psychiatric
nurse
Boolean Operator AND
Keyword 3 Role of
Nurse
manager
OR Overcoming
occupational
violence
The risk of bias will be analysed by performing critical analysis of the methodology of the
study.

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ASSESSMENT 2

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ASSESSMENT 2
PRISMA Chart for the selection of the article
(Source for the PRISMA format: Moher et al., 2009)
Presentation and Discussion of Results
Summary of the results
Itzhaki et al. (2018) conducted a study in order to access the professional quality of
life (ProQOL) of the psychiatric nurses who are exposed to the occupational violence under
the healthcare settings. The data was collected from the 114 mental health nurses based on
the self-administered questionnaire and the analysis of the results highlighted that the

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ASSESSMENT 2
majority of the mental health nurses are exposed to the physical and verbal violence coming
from the patients and their family members under the workplace settings. As an outcome of
the OV, the psychiatric nurses suffer from poor PRoQOL as well as personal QoL. This poor
quality of life decreases the overall quality of care. Gascon et al. (2013) stated that impact of
the OV experienced by the mental health nursing professionals lead to the development of the
burnout. Increase in the level of burnout among the mental health nurses increases the rate of
the nurse turnover. The impact of the OV also hamper the physical health of the nursing
professionals like increase in the level of blood pressure and other problems associated with
the central nervous system. The affect of the physical injury arising out of the OV leads to the
development of the musculo-skeletal disorder and other injuries. Niu et al. (2019) stated that
the main strategies used for the prevention of the OV include training of the nursing
professionals under the supervision of the mental healthcare nurse managers. Other strategies
include conducting proper electronic-based surveillance by the nurse managers in order to
identify the incidences of the OV and to encourage the reporting of the OV by the mental
health nurse. Morphet et al. (2018) highlighted that under the nursing healthcare based
settings, the interventions that is useful for the reduction of the OV include consumer risk
assessment, training of the nursing professionals and aggression management of the mental
health nurses by the nurse managers in order to reduce the ill effects of the OV or the
occurrence of the OV. Lown and Setnik (2018) state that nurse managers play an important
role in reducing the impact of the OV over the mental health (MH) professionals. the nurse
managers must show compassion towards the affected MH nurse in order reduce the severity
of the psychological impact of the OV. On the other hand, the nurse managers in
collaboration with the other healthcare professionals like the psychiatrist in order to educate
the nursing professionals how they must work with compassion and empathy while giving
care to the MH patients in order to reduce the chance of getting victimized with the OV.