The lived experience of the professional nurse who has experienced acts of physical violence perpetrated by confused patients Emily J. Beerman, RN BSN Nurses are 11 times more likely to experience non-fatal on the job assault than the average American worker Nurses are more likely to have an accepted violence-related workmans comp claim than police officers or prison guards Male nurses, nurses under 30 y/o, with less than 9 years experience, without Bachelors degree are more likely to be assaulted 100% of male and 83.7% of female mental health nurses report being physically assaulted Despite these statistics, under-reporting is still considered to be a vast problem sent to Clinical Nurse Managers (CNMs) of neuroscience units of St. Lukes Hospital. CNMs forwarded invitation to professional nurses. Eligible nurses invited to contact PI Informed consent and consent to audiotape obtained 10 Private 1 on 1 interviews conducted with IRB approved questions Interviews transcribed verbatim Transcripts independently analyzed by PI and thesis chair for recurrent themes using van Manens methodology Identified themes presented to participants viafor review and approval. 7 of 10 responded, all responses were in agreement of identified themes Overarching theme of Combat - physical violence perpetrated by confused patients is physically, mentally, emotionally demanding experience for the professional nurse 3 Sub-themes The Attack The Aftermath: assessing the casualties Debriefing Post-Attack: handling the emotional aftermath Consists of the physical act of violence perpetrated by the confused pt and the nurses emotional response and immediate reaction to that violent act Violence included kicks to head, abdomen; punches to head, face; windows broken and staff threatened with broken glass; strangling with stethoscope Elicits strong emotional response: shock surprise stunned anger fear petrified panic I was pretty angry. We cant really fight backyou are just kind of defenseless There was probably like 6 or 7 seconds of anger, like not anything I would lash out or do anything with, but that feeling of, like, you know, very upset It was traumatic. Mostly I think just kind of terrified, scary feelings. He was a very large man and I just didnt know what was going to happen next Immediate reaction to protect others and self You do have that fight or flight instinct of protect yourself...Ive caught myselflike grabbing them We were afraid he might try to attack him and so we kind of lured him out to the hall Refers to the period of time after the attack and immediate feelings/reactions have subsided. If/how nurse seeks help or treatment. Does nurse deem him/herself or pt to have been affected by the attack Under-reporting of violent events would feel ridiculous Its a stigma of like, you kind of feel silly. I should just be fine, you know? dont want to ever be perceived that you provoked someone I dont see what the point would be wasnt in her right mind and she wasnt doing it to be hateful or mean Sympathy for the confused patient you feel bad for them at the same time you are getting assaulted felt bad for her because she was just so confusedso sad Assault by a confused pt versus non-confused patient another instance where the guy was completely with itand that just infuriates you Includes steps taken by nurse to cope with emotional effects. Nurse assigns level of significance to violence and any resulting injuries. Nurse attempts to rationalize the violent events. Minimizing and Accepting these sort of things just come with being a nurseyou learn to accept them charge nurse wanted me to go to EDI didntgot my wind back and I was totally fine it was just like my nerves, bruises and scrapes. I mean I didnt need a CT or anything Contrasting: I think we need to stop using that as an excuse I dont get paid enough for this Laughter and Rite of Passage Frequent laughter throughout interviews and as reaction to violence by self and others Well, it makes a good story We kind of make ita badge an earning notch Can you top that? Justification of violent behavior, either by confusion or by nurses actions felt like it was my fault in some waywhat did I do wrong? What did I do to provoke you? She didnt know anythingit wasnt her trying to hurt me she has some meds on board She wasnt doing it to be hateful or mean. She was scared Assault perceived as a needed learning experience: taught nurses caution and what not to do thought of it more asa learning lesson for me Im a lot more careful now ever since that I was just so, so much more careful from now on Ill never wear my stethoscope around my neck around confused patients dont come out of the darkdont just come up to the bedrail must perfect your art of how to avoid being hit Perceived availability of support Management: probably didnt because I knew nothing would get done my manager was probably there, but I dont remember her being any part of it Contrasting: Hes so goodhe was like do you need a day off and reminded me about the EAP she was asking if I wanted to press chargessecurity kind of took over after that Emergency Department: They kind of make you sometimes feel like why are you here, really? They were super busySo I didnt get a whole lot of sympathy PI knew all participants in some manner PI has experienced violence from confused pt All neuroscience nurses No male nurses Patients receiving late/inadequate pharmacological treatment for delirium Recognizing delirium as a sign of other significant medical condition Opportunity for growth to show we do care about physical, emotional well- being of nurses Multi-site Representative male to female ratio PI unknown to participants PI who has not experienced violence Nurses who work outside neuroscience population Violence at day versus night Questions? Suggestions? Chapman, R., Perry, L., Styles, I., & Combs, S. (2009). Consequences of workplace violence directed at nurses. British Journal of Nursing, 18(20) Chen, W. C., Huang, C. J., Hwang, J. S., & Chen, C. C. (2010). The relationship of health-related quality of life to workplace physical violence against nurses by psychiatric patients. 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