A Review of Literatures on Workplace Violence Against Nurses

Stephen Tee, Yeter Sinem Üzar Özçetin, and Michele Russell-West head “Workplace violence experienced by nursing students: A UK survey”, Nurse Education Today, 2016, vol. 41 pp.30–35

The evidence-based practice, which generally refers to the direct application of scientific, quantitative/experimental research findings to professional practice has been underway in nursing for over two decades (Sarah, Walls 2008). Consequently, nurses are required to provide best evidence-based practice (EBP) wherever possible and according to Hek (2000 p 19-2t 1), to identify this ‘best evidence’, the nurse must undertake an evaluation and critical review of research studies, to see if the research is useful and of sufficient quality to be applied to their practice (Fink, 2005); and part of this process of providing care involves appraising primary research, based on the best available evidence (Elliot, 2001, p 555) and also assessing the quality of the available research which is relevant to their practice (Freshwater and Bishop, 2003k p. 23; Hek, 2000 p 19-21)

This essay is set to review the article, “Workplace violence experienced by nursing students: A UK survey”, by Stephen Tee, Yeter Sinem Üzar Özçetin, and Michele Russell-West which is published in a respectable journal, The Nurse Education Today, (vol 41). The research article pointedly addresses the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement. Now, the appraisal tools for healthcare practitioners assist them in analyzing and critiquing primary research articles, since such models are developed over time in relation to standardized conceptualizations of what constitutes quality and rigor in research and in its reporting. The primary critiquing tool used in this essay is that adapted from (Terry, L 2014), but reference will be made to other critiquing guides and information e.g., Cormack (2000) and Coughlan M, et all (2007)

BELIEVABILITY

Title

The title of the research article is crystal clear and lucid: “Workplace violence experienced by nursing students: A UK survey” (2016). From the lingual collections of the article’s introduction and background, it clearly describes fully the focus of the research (Terry, L 2014). While the nature of the research in appreciating the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement and to recommend strategies that educational institution can implement to successfully manage the impact, is apparent in the aim of the research, there is absolutely nothing indicating strategies that educational institution can implement to successfully manage the impact of these particular variables in the title. Though the title does indicate the research approach used as a survey method and it would not be difficult for people searching online data bases to find this particular study, it however does not indicate that solutions are discussed to manage the impact of the violence, therefore, the title is not concise (Cormack, 2000).

Authors

The qualifications and credentials of the authors are very poorly provided (Terry, L 2014). Only providing the institution and the faculty of the writer, for example: “Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Bournemouth, United Kingdom”, is a very lame manner of attaching qualification to a writer of any professional article. Nothing is known of their postgraduate degrees. Readers are simply left to infer the extent of their educational integrity. We could agree that they all are registered nurses, all of which should be armed with postgraduate degrees, but we could not tell if any has a doctorate. All we were made to know is that they all work within nursing education in a University context.

 This could not therefore suggest that they all have the research skills and expertise to carry out such a study or that any of them have the statistical expertise for the study. (Terry, L 2014; Coughlan, Ryan, F 2007; Cormack 2000)

Abstract

All issues are importantly introduced effectively. It summarizes the research analysis by indicating clearly that it uses recognizable data collection tools. The abstract gives a wide panoramic view of the whole article as it identifies the aim, background, design, findings, and conclusion. The author successfully presents the framework of the whole article in the abstract, containing the summary of the study sample, and also identifies the research tools that have been used. The manner of which the findings were made and the results and a summary of conclusions from these findings. The abstract therefore, is a profound representation of the content of the article itself and everyone can identify just by the abstract whether the article is relevant to their interest or not.

ROBUSTNESS

Literature Review

Centrally, “Workplace violence experienced by nursing students: A UK survey” (2016), was published to appreciate the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement. The purpose is to recommend effective strategies that universities can implement to successfully manage the impact of violence meted on nursing students. These two distinct intentions are well conveyed within this article. The introduction clearly defines violence in the workplace, stating the impact of violence on these individuals’ daily lives and how effort had been made in distant past to target workplace culture. The authors veritably discuss violence itself, how often reported or not these situations are and how these psychologically impact upon the victim. They summarize some research about this topic, and also look at how often exposed student nurses are to such unwanted conduct. There is some exploration of the vulnerability of Student nurses and new graduates entering the workforce which particularly is at an alarmingly high risk as they are often younger, less experienced and less aware of cultural norms and care, which aids understanding of the concept prior to reading the rest of the article.

Enough research materials on the subject matter of violence in the workplace are not consulted and referred to (Ryan, F 2007). They however fail to highlight some important topics in relation to the focus of the article, including prevention and mean of stopping such violence. It is left to the less experienced reader to pursue further explanation of the medical parlance. This could be considered a limitation in the reporting of this research.

Research Problems

Uncontrovertibly, the issue shot into the air like a hurling missile by the article is obviously no small one, taking into account the critical nature of which violence, within professional perimeters, as pitched to a point that it is regarded as one of the profession’s major problem. It is therefore expected that any write-up, article, or research analysis on issues of this global nature must be carefully attempted to ensure the work is unsullied and inerrant; a task which was the analysis was up to.

The major method employed in the whole research analysis, is a survey, designed with questions to be answered voluntarily by students. This method which the article employs, allows the work to enjoy a strong sense of trueness and veracity, due to the huge number of nursing students who answered the survey questions. It was gathered that “657 nursing students responded to the survey. The majority were female (88.3%), 65.9% were 18–27 years old. Most were attending university in the southeast (45.7%). Majority were UK-born (84.8%) and 75.6% of the respondents are whites (English/Scottish/Northern Irish/British). Those who speak English as their first native language was (89.6%). Most were enrolled on BSc Nursing (86.6%) with 38.4% enrolled in 2014 and 36.2% were in their 2nd year.” (p. 32). These great figures profoundly ensured that general representation of the subject matter is established. The data gathered therefore, by the method, thoroughly reflects the truth of the subject matter and the conclusion inferred from it, is worthy of true confidence, precise dependability and believability.

However, it should be noted that the number still does not represent the standings of the majority students. A fatal research problem encountered her is that the total number of student population enrolled in a nursing degree in the United Kingdom across 72 schools of nursing is approximately 60,000, whereas, this study was responded to by only 657 nursing students; just 5% of the student population. Therefore, the research result, based on the host of student who did not attend to it, is not worthy of trust. Rather than base the article solely on survey responses, a wider range of research could have been included Gerrish and Lacey, 2006, 38; Fontana, 2004, p 93),

Study Design/ Theoretical framework

The authors do not state a hypothesis neither was the word used throughout the study, but instead they present a research aim as follows: To appreciate the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement and to recommend strategies universities can implement to successfully manage the impact. The nature of this statement would suggest that it is not an experimental study, but that it is within a quantitative research paradigm. The quality of this study seems to rest in the choice of a quantitative approach, and the choice of data collection instruments. Quantitative research approaches are said to offer a better standard of evidence, with generally greater ability for replication and greater rigor (Kitson et al, 2000 p 149; Duffy, 2005, p 233). The authors do not give credence to that, when they fail to even state in the methodology section or even discuss the choice of a quantitative approach rather, the focus of the section on methods is solely on the instruments that are being used, which is the commercial internet survey provider (SurveyMonkey.com).

Sampling

“The research team sought to ensure there was a sample of universities across all four nations of the UK. The instruction to each Head of School was that it should only be targeted at current nursing students” (p. 32).

 Asample selection of this sort is unacceptable. A very limited detail of sample selection is given. Except stating that current nursing student were targeted, nothing concerning how participants were recruited or the ethical issues considered in participant recruitment was stated. This in fact, constitutes a limitation to this research, as it is not possible to identify if there was any sampling bias, how participants were targeted, who targeted them, and what factors made participants to be chosen (Hek, 2000, p 20; PHRU, 2009, online, Bowling, 2002). From the demographical findings and variables in the article readers may go through the rigors of inferring a sampling that involves female majority, most of whom were attending university in the southeast, and that majority were UK-born, and the respondents ethnic group was, most of whom were enrolled on BSc Nursing in 2014. This is a weakness of the study, as avoiding sampling bias is a crucial elements of quality measurement in primary research within healthcare (Austin, 2001 p 1; Cooper, 2006, p 439; Nuremberg Code, 1949, online).

Ethical Considerations

From the article, it is plainly stated that ethical approval was derived from an appropriate body in United Kingdom: (KCL) Kings College London Research Ethics committee (REC). This signifies good ethical considerations (Cormack 2000; Terry, L 2014). The participant received an information sheet detailing the scope and purpose of the study with clear guidance indicating that they could proceed or exit at any point which shows the level of voluntariness involved. It also states specifically that all data was anonymous Coughlan M, et all (2007). However, it does not directly state if there is an explanation of what information was given to the participants, how informed consent was achieved and if there’s any issue with communication or accessibility for people with different needs

10. Data Collection

The data collection procedure is well described but not too adequately provided still; and the result of this is that it will pose a problem for replication and rigor. It is provided specifically that the survey questions were being uploaded in the format of a commercial internet survey provider (surveymonkey.com). This shows how data was collected and who administered it, an element which should be considered as strength of the study.

A further display of strength in this study, worthy of attention is the use of multiple data collection instruments, and the detail with which they are described, and their provenance accounted for. They have used the Bullying Frequency Questionnaire (table 1), the Source of Bullying Frequency Questionnaire (table 2), the Types of Bullying Questionnaire (table 3), the Effect of Bullying Frequency Questionnaire (table 4), Feelings Experienced When Bullying Frequency Questionnaire (table 5) and the Reporting Bullying Frequency Questionnaire (table 6).

A major problem with this data collection tool, a questionnaire, is that the researcher is not present when the questionnaire is being completed. It is therefore not possible to check if questionnaires have been honestly answered or if they were actually completed by the intended target (Gillham, 2000, p 48). While having the researcher present, however, could also introduce bias or influence of some kind, particularly in vulnerable people (Bowling, 2001).

Data analysis

Very powerful statistical analyses were carried out by the author using a computer-based management system and they then states that it was exported to the SPSS21 Statistical Software (IBMSPSS Statistics v21). How p. values are to be interpreted are discussed at reasonable interval (Terry, L 2014), which is a strength to the study that states that figures and percentages were used in the presentation of the findings depending on the data. It should be borne in mind, however, that the authors carried out their statistical analyses using SPSS 21, which is an established computer-based statistical program previously unknown to the researchers. Anyone who does not have the requisite knowledge of these programs would find it hard to determine their appropriateness here Coughlan M, et all (2007). The level of specialist statistical knowledge required to understand this would be significant. So, rather than giving a shallow explanation on what program was used, more transparency could have been achieved by this study if an explanation on how the program was used is included (Duff, 2005 p 234). The research instruments are only stated and never explained in detailed description whereas according to (Johnson and Onwuegbuzie, 2004 p 14) it is good that the research instruments are explained in such detail, because it helps overcome one of the limitations of quantitative research, that of not asking the right questions to elicit answers that relate to person al experience.

Findings

The findings of this study are accurately presented on tables which can be easily interpreted (Terry, L 2014; Coughlan M, et al 2007). The findings are clearly represented on each table in a simple and highly accessible way. The believability of the finding is an important question which the study was profoundly up to. The huge number of students who responded to the survey questions ensured proper representation of different views. This means the research results are plausible, and relate to established procedures laid down for statistical analysis, Rosswurm and Larrabee, 1999 p 317; Pepler et al, 2006, p 23. It is therefore very hard, if not impossible to establish doubts about these findings, though it may possess a potential bias based on the sampling as discussed earlier. However, the issue of sampling bias cannot just be overlooked. More transparency in reporting of key elements of this study would have made it easier to determine whether these results constitute good evidence for practice. Moreover, the authors’ sole use of tables is a little drowsy. Diagrams or charts are also statistical tools which could have help a wider range of persons to fully understand the rate of the subject matter in the study (Daggett et al, 2005, p 255; Donovan, 2002)

Usefulness of the Study

The article in general is quiet balance and very detailed considering the gravity and complexity of the subject matter of the study, as allegations of violence and harassments is no small issue. It is quite useful in forming a judgment on the extent and the fast-increasing rate of violence in the work place, the most unpalatable truth revealed by this UK survey is that an unacceptably high proportion of nursing students experience bullying and harassment whilst on clinical placement.  Limitations of the study was never acknowledged, making it difficult to pick out pitfalls from the article and avoid them.

Conclusion

The article is accurately and flawlessly based on the finding that was obtained from the survey results (Terry, L 2014; Cormack 2000). The authors however include some extraneous opinions not obtained from any research works. It is worthy of note that the conclusion is a very detailed summation of the complexity of the findings of a work that is very easy to read and interpret.