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Article Excerpt
ABSTRACT
* THE HIGH INCIDENCE OF VERBAL ABUSE directed toward perioperative nurses by surgeons has been the subject of recent research studies.
* REPEATED INCIDENTS of verbal abuse in the OR contribute to increased incidence of errors, low morale, and high turnover among nursing staff members.
* ASSERTIVENESS TRAINING that focuses on conflict resolution and communication skills is an effective method of coping with verbal abuse.
* EACH MEMBER is a vital part of the perioperative team. Any disruption to the team, including verbal abuse, can compromise patient safety. Collaboration among team members is critical to ensure safe patient outcomes. AORN J 79 (January 2004) 148-164.
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The article "Assertiveness training to prevent verbal abuse in the OR" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.
Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Jan 31, 2007.
Complete the examination answer sheet and learner evaluation found on pages 169-170 and mail with appropriate fee to
AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711
or fax the information with a credit card number to (303) 750-3212.
You also may access this Home Study via AORN Online at www.aorn.org/journal/homestudy/default.htm.
BEHAVIORAL OBJECTIVES
After reading and studying the article on assertiveness training to prevent verbal abuse in the OR, the nurse will be able to
1. identify the dimensions of verbal abuse,
2. explain how episodes of abuse have evolved historically in the perioperative setting,
3. describe the effects of verbal abuse, and
4. discuss interventions that can be used to prevent and manage verbal abuse.
Verbal abuse is a common form of workplace violence in today's health care environment. Of 461 nurses surveyed in 1999, 94% had experienced some form of verbal abuse. (1)
DIMENSIONS OF VERBAL ABUSE
The term verbal abuse frequently is defined as communication perceived by a person to be a harsh, condemnatory attack, either professional or personal (Table 1). It may be conveyed with tone, manner, or nonverbal cues. (2) Abuse in the health care arena consists of two dimensions, horizontal and vertical abuse. Horizontal abuse is abuse directed between two equally ranked coworkers, such as between two nurses. Vertical abuse is use of inappropriate power toward an actual or perceived subordinate. Vertical abuse occurs when a surgeon directs abuse toward a nurse. A nurse directing abuse toward a subordinate nurse or coworker (eg, scrub technician) or directing inappropriate behavior toward a patient also are examples of vertical abuse. Vertical abuse directed from the surgeon toward a nurse usually is done in the presence of others. Vertical abuse between two nurses, on the other hand, usually occurs in a private area.
A recent study conducted in Veteran's Health Administration hospitals noted that more than 50% of the physicians were unaware of the effects verbal abuse had on nurses. (3) Other recent studies have shown a high incidence of verbal abuse directed at perioperative nurses by surgeons. (4-7)
HISTORICAL PERSPECTIVE
The perioperative setting can be very stressful. A surgical team consists of the anesthesia care provider, the surgeon, an RN first assistant (RNFA) or a resident physician, a scrub person, and a circulating nurse. With the exception of the anesthesia care provider and the circulating nurse, team members must remain within the sterile area and, therefore, are unable to leave when verbal abuse occurs. The anesthesia care provider continuously monitors the patient during the procedure and is required to be in the OR during the entire procedure. Although the circulating nurse may leave the OR to retrieve supplies or medications, he or she must return quickly, and therefore, is almost as vulnerable to abuse as team members confined to the sterile area. The victims of abuse must stay and listen to the abusive comments until someone can provide relief. If relief can be obtained at all, it may be a matter of minutes or hours, particularly if the individual is part of an on-call team.
In the past, the perioperative setting allowed for some laxity with jokes, remarks, or pranks. This was accepted in the perioperative cul0are as a method of stress reduction. Problems occurred, however, when the behavior was unwelcome by staff members or if the behaviors included lewd remarks or sexual innuendos. These remarks could spread through gossip to other staff members and could create an environment of unrest and decreased trust. (1) This laxity has become increasingly less acceptable in the current health care environment.
EFFECTS OF ABUSE
Negative effects on patient care, work satisfaction, and turnover rates have been reported after episodes of verbal abuse. (6) One group of researchers identified decreased morale, decreased productivity, and increased errors related to verbal abuse) Verbal abuse frequently is unprovoked and unexpected, and victims of the attack often internalize the event. The initial reaction to the event may be anger, humiliation, shock, or surprise. The individual may think, "How could Dr Smith say something like that to me?" or "I didn't do anything to deserve that!"
Repeated events involving the same surgeon may lead to feelings of inadequacy, disgust, or frustration. The victim may begin to feel responsible for the event having occurred. The surgeon may enjoy the feeling of power he or she has over the victim. Common thoughts perioperative nurses may have after experiencing abuse include the following.
* "Why can I never do anything right when I work with Dr Smith?"
* "I never have problems with other surgeons."
* "I must be doing something wrong to cause this reaction."
* "Why is it always me she is upset with?"
* "She never yells at the other nurses."
* "I hate working in this room!"
* "Why am I so stupid when I work with Dr Smith?"
* "Why do I let her upset me so much that I start crying?"
The consequences of verbal abuse can have long-term effects on the working relationship of the OR team and on patient care. The OR requires a collaborative effort among surgeons, nurses, anesthesia care providers, and ancillary...
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