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Negative Outcomes For Nurses: Hostile Work Environments Essay

Journal Article Critique

Article

Pai H., & Lee S., (2011) . Risk factors for workplace violence in clinical registered nurses in Taiwan. Journal Of Clinical Nursing [serial online]. May 2011;20(9-10):1405-1412. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011010111&site=ehost-live&scope=site

Background Information

The authors, Pai and Lee, stated their aim clearly and concisely. They created a structured abstract, which listed and discussed the topics of background information, design, methods, results, conclusions, and the study’s relevance. They supplied the reader with background information that supported their research objective. Reading the abstract alone, one has a clear picture of what is going presented in the article. The authors used key words to place identifiers on their article, which in turn, helps other researchers find their work. The sections were an excellent summary of the material found within the study.

Review of Literature

Pai and Lee cited twenty different sources of information in the literature review. This presented a thorough literature review for their study, by showing supporting evidence. Literature was grouped into topics of workplace violence (WPV), risk factors, after effects, and psychological consequences, such as post-traumatic stress disorder (PTSD) (Pai & Lee, 2011). Though many of the cited articles are greater than five years old, there is a clear relationship between the cited work and the authors’ study objectives. Additionally, sources included many reputable organizations like The World Health Organization, The National Institute For Occupational Safety, and The American Psychiatric Association. Though not included in the literature review, the authors’ separated their conceptual framework into its own sub-heading. By using the ecological occupational health model, Pai and Lee, explained the model’s theory, and based their research questions on it.

Methodology

The researchers used a quantitative descriptive cross-sectional methodology for their exploratory study. In the quantitative study approach, one tests a theory by asking specific questions related to an existing problem. Variables, given a numeric value, are measured and quantified by statistical equations. Pai and Lee were looking to find if link between impaired mental health and exposure to mental and physical abuse existed in the Taiwanese nursing population. Descriptive studies focus on the characteristics of or events occurring in a population. In Taiwan, many nurses were recounting aggressive interactions while at work. Using a cross-sectional study, data was collected once; in the hope it was representative of the population. Surveys, mailed to participants’ homes, were used to collect data, which was then analyzed to determine the frequency of events and associations between variables. Prior to conducting the study, the researchers received approval from the Taiwan Nurses Association. This shows the authors were principled and ethical in obtaining their data (Pai & Lee, 2011).

Data Analysis

The study’s population, selected randomly from 700 members of The Taiwan Nurses Association, was representative of all nurses in Taiwan. By using random selection and having a high response rate of 545 (77.9%), the researchers gained external validity for their study. This means they can be confident that the study will apply to the nursing population. An adapted version of The Workplace Violence Questionnaire (WVQ) and a PTSD scale were used to collect the data. By recruiting a diverse panel of experts to review the adapted survey, Pai and Lee showed proof of the study’s internal validity. The survey used yes/no questions and Likert scales. The researchers’ used statistical techniques, including frequency distributions, odds ratios, confidence intervals, and multiple regressions, to develop easily read result tables.

Using a computer based program the data was analyzed. The frequency distribution was used for demographical information and number of WPV incidents. Pai and Lee took the four types of WPV, physical abuse, verbal abuse, bullying/mobbing, and sexual harassment, and calculated the number of incidents with a frequency distribution in relation to the executor of violence, the nurses’ reactions, and the PTSD scores. The authors determined younger age and high anxiety were linked to verbal abuse using odds ratio and confidence intervals. The data was laid out in labeled tables that the reader could easily and review (Pai & Lee, 2011).

Conclusion

As the conclusions were presented, the authors were able to support their findings with evidence from the literature. The researchers did surmise possible causative factors for incidents of abuse, such as nursing shortages, the economy, and verbal miscommunication and supported those factors with additional evidence. Study limitations, like recall bias and non-response bias, where addressed due to the nature of the study’s data collection method. Cross-sectional design only finds for an association between variables and the authors’ stated that causation could not be completely concluded. By using the word indicated in their final statement, Pai and Lee stated there was a relationship between the variables (Pai & Lee, 2011). Overall it was found that the authors touched on all the major points that should be included in the conclusion.

​The conclusions presented in this report are well supported by the evidence gathered in the study. By conducting a thorough literature review, Pai and Lee were able to support their individual findings with similar results from other previous studies in the field. In this study, the participants are asked to recall incidents of WPV. The surveys asked questions as to risk factors of WPV, nurses’ emotional health after exposure, and how in the moment, the nurses’ responded. Qualified authorities independently reviewed the adapted WVQ survey and assured validity (Pai & Lee, 2011). The PTSD scale has been used in similar studies in the field, which lends to it credibility. These measures helped strengthen the internal validity of the research. The random sampling process used along with the high response to the survey lend to the study’s external validity.

By controlling the possibility of extraneous variables, the authors were able to keep bias to a minimum. The article was peer-reviewed, submitted for publication, and quickly in print, which adds to the integrity of the findings. ​May ethical dilemmas can arise when conducting a research study. One must be assured that no harm will come to the participants, that the study is conducted correctly, and that findings are reported accurately. In this study, the researchers reported all aspects and steps of the study in a clear manner. All the findings were supported and the article was submitted for peer-review. The study was appraised and approved prior to commencing by an institution review board. Letters describing the study provided informed consent to participants. Mailed to the home, nurses were able to complete the study in privacy. No names were requested on the returned surveys to help provide confidentiality. Mailing fees were paid by the study.

There was no compensation for completing the survey (Pai & Lee, 2011). All of these factors would lead one to surmise that this study was done ethically. ​The researchers used a quantitative descriptive cross-sectional methodology for their exploratory study. In quantitative research, one pre-designs a plan to monitor and gauge variables in their natural condition. Here the researchers had predetermined their design for research. They asked for actual numbers of incidents of WPV. Descriptive research, a non-experimental design, looks at circumstances or events that have occurred. Pai and Lee were looking to past events such as WPV that had occurred in the last year (Pai & Lee, 2011). The cross-sectional method, which often uses surveys to measure events at a set point in time, has the intent to uncover relationships between variables.

By asking which circumstances were related to what type of violence occurrence, the researchers were searching for any relationships between the variables. Insight, definition, and discovery are goal of exploratory studies. The authors wanted to determine the likelihood of poor mental health and who is at risk for violence after WPV. Variables in this type of research are given numeric assignments, which are measured and quantified by statistical equations. Pai and Lee used yes/no questions and Likert scales in their surveys to collect the data (Pai & Lee, 2011). The data can then be analyzed with statistical techniques to look for associations between the variables. ​The qualitative research method is based on the principle that, in any event, multiple realities or views exist. Research is driven by the thoughts and feelings of the people contributing to body of work. Surveys, observations, and interviews are some of the means of gathering data for qualitative research. Qualitative research methods are classified as phenomenologic, grounded theory, or ethnographic research.

Ethnographic research focuses on groups with commonality, like nurses, in Pai and Lee’s study. The nurses are the culture group being studied. In grounded theory, one takes an event and asks the participants to describe their perception of it. Phenomenologic research, done over time, is like painting a detailed picture of what the individual lived through. Pai and Lee, in their quantitative study, were attempting to uncover predictors for WPV and if exposures caused emotional distress (Pai & Lee, 2011). Looking directly at the research questions, the study authors wanted to know the actual rate of WPV in Taiwan, how nurses reacted to WPV, what was the standing of their mental status after the event, and what events influenced which type of violence. With the phenomenological research method, one could gain the nurses perspectives of the events by asking the questions: have you been exposed to WPV, what do you think caused the event, how did you react at the time of the event, and emotionally how do you feel after the event. This study format could be done through private interviews, in a setting comfortable to the participant.

One limitation would be the study size, since these types are usually small, it may not be representative of all Taiwan nurses. An observational method, like the ethnographic study, would be considered unethical, since the nurses would be exposed to potential harm. Grounded theory could not be used because it looks only at one event, and the questions are related to varying types of WPV events. The researchers could possible benefit by conducting a mix-method study in which a small group of the sample is interviewed. These personal accounts may lend some additional perspectives to the study that were not asked or answered in the quantitative portion, perhaps leading the researchers to identify additional areas of study.

Problem Statement

When nurses are faced discord in the workplace, employers should expect negative consequences. Workplace violence (WPV) and hostile work environments (HWEs) are broad terms that can encompass many different events and behaviors. Physical and verbal abuse, sexual harassment, bias, slander, disparaging comments, undermining, bullying, and intimidation are all deeds associated with WPV and HWEs (Chipps, Stelmaschuk, Albert, Bernhard, & Holloman, 2013). The term mobbing, a type of WPV, is the causative factor in nurses’ resignations (Yildirim & Yildirim, 2007; Efe & Ayaz, 2010). Abuse, spoken or bodily, and menacing is an increasing matter faced by medical facilities and staff alike. The effects of these incidents leads to decreased morale, poor job satisfaction, possible risks in patient safety, and an increase in nursing attrition (Samir, Mohamed, Moustafa, & Abou Saif, 2012).

In a study by Chapman, Perry, Styles, and Combs (2009), after experiencing HWEs, some nurses felt uncertain if they could adequately perform their jobs, while others reported the emotional distress impacted their family life (Champman, Perry, Styles, & Combs, 2009). The perpetrators of abuse range from patients and their families, to nurse leaders and doctors, and even to other nurses (Rowe & Sherlock, 2005). According to Yildirim and Yildirim (2007) “10% of the nurses in our study considered committing suicide from time to time to escape from mobbing,” a statement which really pushes forward the importance of gaining understanding of the cause and effect of WPV and HWEs (Yildirim & Yildirim, 2007). With the nursing shortage looming, now is the time to fix the ongoing incidents of WPV and HWEs, to weed out its roots, and to find strategies to decrease the residual negative impact.

Annotated Bibliography

Chapman R., Perry L., Styles I., Combs S. (2009) . Consequences of workplace violence ​directed at nurses. British Journal Of Nursing [serial online]. November 12, ​2009;18(20):1256-1261. Retrieved from http://wguproxy.egloballibrary.com/login?user= true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010 470326&site=ehost-live&scope=site

This qualitative study asks nurses to describe what they believe to be the outcome of WPV on themselves, the facility, and the perpetrator. In this study the perpetrator is most commonly the patient. Abuse ranges from verbal to severe physical. WPV is thought of as something to be expected by the nurses but feel it affects their emotional well being negatively.

Outcomes for the patient perpetrator could be avoidance or possible restraint. The facility faces financial repercussions with nurses increasing call outs, needing physical and mental therapy, and paying disability. Nurses feel patient care is compromised to other patients as well. The study is lent credibility by its publication in a peer-reviewed nursing journal, as well as by its numerous references that help support the researchers’ findings. The recommendations put forth are for policy changes to protect staff, education and training in WPV, along with hiring security personnel. Information from the outcomes of WPV will be used in the research. This study, based in Australia, shows that WPV is a problem for nurses’ not only in the U.S., but also throughout the world (Champman et al., 2009).

Chipps E., Stelmaschuk S., Albert N., Bernhard L., Holloman C. (2013) . Workplace bullying in the or: Results of a descriptive study. AORN Journal [serial online]. November 2013;98(5):479-493. http://wguproxy.egloballibrary.com/login?user =true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2012347492&site=ehost-live&scope=site.

The researchers’ in this study are seeking to establish if links are present between bullying and emotional distress and bullying and compromised patient safety. In addition, they are also correlating whether bullying increases in relation to position, race, sex, experience, amount of time working in the OR, and which facility one works at. The study sample is comprised of staff working in two hospital operating rooms (OR). The findings reveal few staff members identify as being bullied but more than 34% qualify as such, showing that not all negative acts are recognized as bullying. RNs rank second to non-nurse staff as executors of negative behaviors. The predictor of increasing ones risk of exposure to a HWE is employment at hospital A and being Caucasian.

Patient safety is felt to be a concern by a small percentage of the staff. The authors conclude that negative behavior can affect mental health and job satisfaction, leading to staff resignations. To avoid this, recommendations should include teaching communication techniques, developing the policy to diminish bullying, and setting a standard of what is acceptable behavior. One can take the recommendations in this paper to help support a need for change at their own facility. Published in a peer-reviewed journal, this paper cities numerous similar articles, bolstering its’ credibility and relevance to practice (Chipps et al., 2013).

Efe S. Y., & Ayaz S., (2010) . Mobbing against nurses in the workplace in Turkey. International Nursing Review [serial online]. September 2010;57(3):328-334. Retrieved from http://wguproxy.egloballibrary.com/login?user=true&url=http://search. ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010763638&site=ehost-live&scope=site

Efe and Ayaz are attempting to indentify the causative factors related to mobbing and to quantify the nurses’ exposure to it. The authors’ use several citations to help define what they believe to encompass mobbing behaviors. This is helpful in that it broadens the definition of what constitutes WPV and HWE and can be used in the research. Though verbal abuse is not defined in mobbing behavior, the researchers’ feel the nurses do identify it as a characteristic, which explains the discrepancy in the self-reported result and mobbing scale result. This study’s finding for the head nurse as the mobbing perpetrator was supported by citations from two additional resources. Improper communication is pointed to as a cause of mobbing. Mobbing behavior affects the emotional wellbeing of the nurses in turn affecting their home life and job satisfaction. Statistics from this study will be used in the research paper. This peer-reviewed article is published in The International Nursing Review, lending to the papers’ trustworthiness (Efe & Ayaz, 2010).

Laschinger H., Grau A., Finegan J., & Wilk P., (2010) . New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal Of Advanced Nursing [serial online]. December 2010;66(12):2732-2742. http://wguproxy.egloballibrary.com/ login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010940002&site=ehost live&scope=site

This study looks at the use of structural empowerment in relation to exposure to WPV by new graduate nurses in Canada. Nurses, in the workforce less than three years, are experiencing burnout due to bullying. The results of the study show that there are less reports of bullying in facilities that provide an empowered structure environment. Additionally, a high rate of bullying is still present among new nurses, which is related to increasing burnout and emotional distress. This study, published in a peer-reviewed journal, provides excellent strategies for structural empowerment that will be useful in the research.

Many of the findings of the researchers are corroborated by the cited references adding integrity to the study. Dr. Laschinger, a professor at The Arthur Labatt Family School of Nursing, also serves as the Nursing Research Chair in Health Human Resources Optimization and has done numerous studies related to this topic (Laschinger, Grau, Finegan, & Wilk, 2010).

MacKusick C. I., & Minick P., (2010) . Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. MEDSURG Nursing [serial online]. November 2010;19(6):335-340. http://wguproxy.egloballibrary.com/login?user=true&url=http ://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010889700&site=ehost-live&scope=site.

This article focuses on why nurses are choosing to leave the clinical setting. In this study, MacKusick and Minick are using qualitative methods to explore the nurses’ feelings as to what is driving them to leave direct patient care. The authors’ findings are from ten nurses, whom declare emotional exhaustion, abuse, and moral conflict in regard to patient care as the cause. The authors’ state that having the opinions of only ten nurses is a small sample and limits the results of this study, but it is useful in that, once understood, a retention initiative can be enacted. They also cite numerous authorities on the impending nursing crisis, which gives relevance to the need for this study. This article is peer-reviewed, which supports it credibility. The perceptions of the nurses will be included in the research paper (MacKusick & Minick, 2010).

Moceri J. T., (2012) . Bias in the nursing workplace: Implications for latino(a) nurses. Journal Of Cultural Diversity [serial online]. September 2012;19(3):94-101. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011680780&site=ehost-live&scope=site

Dr. Moceri is trying to ascertain the levels of bias and it’s effect on attrition in the Latino(a) nursing population in this study. She is defining what behaviors constitute bias and why it occurs. The findings show, a large number of the nurses, witness and are victims of bias mainly because of their race. These incidents do influence their decision to stay at the current employer. Dr. Mockery is able to see the father impact of nursing attrition in relation to the nursing shortage. She has citied many references, which support her views on how the hostile environment effects negative outcomes, increasing the articles credibility. Factors reported to be incidents of bias will be used in the research to help show the number of different acts cans have a negative impact. The article is published in a peer-reviewed journal of nursing. As the diversity of nurses grows, more understanding of cultures is needed, making this study relevant (Moceri, 2012).

Pai H., & Lee S., (2011) . Risk factors for workplace violence in clinical registered nurses In Taiwan. Journal Of Clinical Nursing [serial online]. May 2011;20(9-10):1405- 1412. http://wguproxy.egloballibrary.com/login?user=true&url=http://search. ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011010111&site=ehost-live&scope=site

With high reports of WPV in Taiwan by nursing personnel, Pai and Lee, describe its impact on emotional health and what puts one at risk for exposure. They find that lack of communication and young age precipitates incidents of WPV. The most common offenders are patients but coworkers and managers were also indicated. Verbal and psychological abuses lead to higher PTSD scores and anxiety levels. The authors are able to correlate their findings with other studies, adding credibility to their research. Of 700 RNs mailed the study questions, 545 (77.9%) returned the surveys. This high response rate shows that the sample is probably representative of the population Taiwan’s’ RN workforce. Statistical information related to PTSD will be used in the research. Both authors of the study hold a Doctorate in Nursing. The study is published in a peer- reviewed journal (Pai & Lee, 2011).

Rowe, M., & Sherlock, H. (2005). Stress and verbal abuse in nursing: do burned out ​nurses eat their young?. Journal Of Nursing Management, 13(3), 242-248. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=15819837&site=ehost-live&scope=site

In this study, Rowe and Sherlock are looking at lateral or nurse-to-nurse verbal abuse. Types and sources and effects and outcomes of verbal abuse are also investigated. Staff nurses are cited as the most common perpetrator of verbal abuse. Feelings of anger, followed by sadness and hurt were the most common emotional response to abuse. Most nurses cope by trying to clarify miscommunication with the abuser. The researches feel the abuse can affect the rate of absenteeism, decrease the nurses’ ability to work proficiently, increase stress levels, and lead to financial risk for the facility. Though this article is greater than five years old, it is cited in many other research studies, increasing its credibility and relevance. The strategies for improvement will be used in this research. The article is published in a peer-reviewed journal. The authors are a Doctorate and a Masters prepared nurses. They cite numerous researchers on the definitions of abuse, as well as, the outcomes of abuse, providing researched-based information (Rowe & Sherlock, 2005).

Samir N., Mohamed R., Moustafa E., & Abou Saif H., (2012) . Nurses’ attitudes and Reactions to workplace violence in obstetrics and gynaecology departments in Cairo hospitals. Eastern Mediterranean Health Journal = La Revue De Santé De La Méditerranée Orientale =Al-Majallah Al-Ṣiḥḥīyah Li-Sharq Al-Mutawassiṭ [serial online]. March 2012;18(3):198-204.
http://wguproxy.egloballibrary.com/login? user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=22574471&site=ehost-live&scope=site

Focusing on obstetrical (OB) and gynecological (GYN) nurses, this study is attempting to gauge nurses’ responses to WPV and investigate the types of WPV occurring in Cairo’s hospitals. According to the findings, a large percentage of nurses experience WPV. Patients’ relatives, followed by managers, are the majority of abusers. Psychological abuse was used more frequently than physical abuse. Nurses feel that understaffing and heavy workloads are the main factor instigating abuse. The findings are supported by similar studies that the researchers cite, which impart reliability to the article. Out of 500 nurses given the survey, 416 completed it, showing that the sample is most likely demonstrative of Cairo’s OB/GYN nurses. The consequences of WPV from this peer –reviewed paper will be used in the research (Samir et al., 2012).

Yildirim A., & Yildirim D., (2007) . Mobbing in the workplace by peers and managers: Mobbing experienced by nurses working in healthcare facilities in Turkey and its effect on nurses. Journal Of Clinical Nursing [serial online]. August 2007;16(8):1444-1453. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohost .com/login.aspx?direct=true&db=mnh&AN=17655532&site=ehost-live&scope=site

Yildirim and Yildirim are describing the coping strategies and negative effects of mobbing on nurses in Turkey. Mobbing is experienced by more than three fourths of the nurses in the study and it affects them negatively both physically and emotionally. Sadly a small percent of nurses considered suicide as a mean to escape mobbing while others try to communicate with the abuser, report the behavior, or work more cautiously. The authors cite studies from around the world that support their findings and opinions lending to the study’s credibility. Though this paper is more than five years old, other authors in this research have cited it giving relevance to its use. The reference list provides an excellent source of background information on the subject of WPV. The resolutions plan discussed in this paper will be used in the research (Yildirim & Yildirim, 2007).

​The evidence presented shows that there are many forms of WPV and HWEs all of which result in negative outcomes. Negative outcomes can affect not only the nurses, but also the patients and facilities. With the nursing shortage worsening, facilities are struggling to keep nurses from leaving. As reported by The American Association of Colleges of Nursing, the U. S. nursing shortage, previously 8% is climbing (as cited in MacKusick & Minick, 2010, p. 335). Over the next twenty years, The World Health Organization projects that the healthcare workforce will face even more deficiencies on top of the current shortage (as cited in Laschinger et al., 2010, p. 2732).

This is not just a U.S. problem, but worldwide, as shown by the diversity of countries that the studies are from. The impact on facilities ranges from patient safety and malpractice to the cost of nursing turnover. Nurses exposed to WPV have increased absenteeism, can require workman’s’ compensation for injuries, or counseling for emotional exhaustion (Champman et al., 2009, Chipps et al., 2013). Compromised patient safety is a concern as it exposes patients to harm and facilities to malpractice suits. In the study involving the Australian nurses exposed to WPV, patients are restrained for long periods and nurses admit to avoiding patients, in turn decreasing the ability to care for them properly (Champman et al., 2009). In the study by Rowe and Sherlock (2005), 13% of nurses feel that exposure to verbal abuse increased incidents of patient care errors while in Chipps et al. (2013) study, nurses reported a 6% increase in medical errors (Chipps et al., 2013, Rowe & Sherlock, 2005).

Though these numbers may not seem significant, any error resulting from forms of WPV is inexcusable and a huge liability for medical facilities. HWEs also lead to decreased job satisfaction, which, in time, leads to increased nurse attrition; costing companies thousand of dollars annually from loss and hiring of new staff (Champman et al., 2009, MacKusick & Minick, 2010). The effect of WPV and the HWE on nurses is disheartening. Nurses report feelings of abandonment, sadness, humiliation, and anxiety from HWE, which has driven them from the clinical setting (MacKusick & Minick, 2010). High rates of mobbing by managers is leaving nurses to feel incompetent; negatively impacting life outside of work (Efe & Ayaz, 2010, Yildirim & Yildirim, 2007). It has also increased stress and anxiety levels to a point where physical symptoms appear. Headache, gastric distress, PTSD, suicidal thought, extreme fatigue, and despair are the after effects of WPV and HWE reported by nurses (Efe & Ayaz, 2010, Pai & Lee, 2011, Yildirim & Yildirim, 2007). With the evidence presented above, employers need to start initiating better protocols and policies. Defining and addressing WPV and HWE will help to keep staff and patients safe. ​Surveys and interviews are the tools of choice by the researchers in these studies.

Demographical information is collected in all of the studies with a self-report survey except for one, which uses interviews only. Almost all of the studies look at WPV and HWE and are trying to ascertain the types of abuse, source of abuse, response to abuse, and outcome after abuse. The Maslach Burnout Inventory-General Survey (MBI), used to measure emotional exhaustion, personal worth and pessimism, along with The Negative Acts Questionnaire-Revised (NAQ-R), used to measure bullying behaviors are the instruments for two of the studies (Chipps et al., 2013, Laschinger et al., 2010). Dr. Laschinger also uses the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II) that she developed in 2000 to measure structural empowerment (Laschinger et al., 2010). Rowe and Sherlock, creating a survey based on Cox’s Verbal Abuse Survey and Manderino and Berkley’s Verbal Abuse Scale, attempt to determine types and frequency of verbal abuse, along with other variables such as the abuser, reaction to abuse, and outcomes (Rowe & Sherlock, 2005).

Dr. Moceri developed The Nursing Workplace Bias Scale to gauge intent to leave related to bias (Moceri, 2012). Samir et al., (2012) in a two-part survey made for this study, calculate similar variables of abuse, frequency, type, source, and response (Samir et al., 2012). While the studies by Efe and Ayaz and Yildirim and Yildirim both use different mobbing scales, the variables’ characteristics are similar. Efe and Ayaz conducted taped interviews, using predetermined questions for the qualitative part of their study (Efe & Ayaz, 2010). The Australian nurses study measuring similar variables of abuse types, offenders, outcomes, and perceptions, used surveys consisting of open-ended questions and demographical information, as well as, semi-structure taped interviews (Champman et al., 2009). The only study to use taped interviews alone for data collection is by MacKusick and Minick. This study stands out as different from all of the other studies as there is no direct question asking about WPV or HWE. The subjects are asked open-ended questions to relate their perspective of bedside nursing, personal experiences and decisions to terminate positions (MacKusick & Minick, 2010).

​In the three studies using qualitative or mixed method, the interview information is transcribed looking for themes and patterns, which are then coded into findings (Champman et al., 2009, Efe & Ayaz, 2010, MacKusick & Minick, 2010). Champman et al. (2009) is the only research group that not only reviews the findings with the participants but also has outside experts scrutinize their work to establish validity (Champman et al., 2009). By not reviewing the transcriptions of interviews with the participants, the researchers could misconstrue their perspectives, leading to errors in the findings. Additionally, the researchers should have an independent panel examine their findings to help strengthen to the research.

References
Chapman R., Perry L., Styles I., Combs S. (2009) . Consequences of workplace violence ​directed at nurses. British Journal Of Nursing [serial online]. November 12, ​2009;18(20):1256-1261. http://wguproxy.egloballibrary.com/login?user= true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010 470326&site=ehost-live&scope=site

Chipps E., Stelmaschuk S., Albert N., Bernhard L., Holloman C. (2013) . Workplace bullying in the or: Results of a descriptive study. AORN Journal [serial online]. November 2013;98(5):479-493. http://wguproxy.egloballibrary.com/login?user =true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2012347492&site=ehost-live&scope=site. Efe S. Y., & Ayaz S., (2010) . Mobbing against nurses in the workplace in Turkey. International Nursing Review [serial online]. September 2010;57(3):328-334. http://wguproxy.egloballibrary.com/login?user=true&url=http://search. ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010763638&site=ehost-live&scope=site Laschinger H., Grau A., Finegan J., & Wilk P., (2010) . New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal Of Advanced Nursing [serial online]. December 2010;66(12):2732-2742.
http://wguproxy.egloballibrary.com/ login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010940002&site=ehost-live&scope=site MacKusick C. I., & Minick P., (2010) . Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. MEDSURG Nursing [serial online]. November 2010;19(6):335-340. http://wguproxy.egloballibrary.com/login?user=true&url=http ://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010889700&site=ehost-live&scope=site. Moceri J. T., (2012) . Bias in the nursing workplace: Implications for latino(a) nurses. Journal Of Cultural Diversity [serial online]. September 2012;19(3):94-101. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011680780&site=ehost-live&scope=site Pai H., & Lee S., (2011) . Risk factors for workplace violence in clinical registered nurses In Taiwan. Journal Of Clinical Nursing [serial online]. May 2011;20(9-10):1405- 1412. http://wguproxy.egloballibrary.com/login?user=true&url=http://search. ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011010111&site=ehost-live&scope=site Rowe, M., & Sherlock, H. (2005). Stress and verbal abuse in nursing: do burned out ​nurses eat their young?. Journal Of Nursing Management, 13(3), 242-248. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=15819837&site=ehost-live&scope=site Samir N., Mohamed R., Moustafa E., & Abou Saif H., (2012) . Nurses’ attitudes and Reactions to workplace violence in obstetrics and gynaecology departments in Cairo hospitals. Eastern Mediterranean Health Journal = La Revue De Santé De La Méditerranée Orientale =Al-Majallah Al-Ṣiḥḥīyah Li-Sharq Al-Mutawassiṭ [serial online]. March 2012;18(3):198-204. http://wguproxy.egloballibrary.com/login? user=true&url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=22574471&site=ehost-live&scope=site Yildirim A., & Yildirim D., (2007) . Mobbing in the workplace by peers and managers: Mobbing experienced by nurses working in healthcare facilities in Turkey and its effect on nurses. Journal Of Clinical Nursing [serial online]. August 2007;16(8):1444-1453. http://wguproxy.egloballibrary.com/login?user=true&url=http://search.ebscohos
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