Disruptive Behavior in Health CareGussie LaguitanCalifornia Baptist UniversityAuthor NoteThe paper is submitted to Dr. Bobst on September 23, 2019, in partial fulfillment of the requirements of NUR 470 Christian Leadership in Nursing/ Case Management.Disruptive BehaviorNursing is a great privilege, but there are aspects of a nurse that is not often spoken of and is considered the elephant in the room, and that is disruptive behavior. It is not only limited to first-year nurses but nurses in general. It could stem from a failure to communicate or the lack of communication, Murray defines disruptive behavior as “overt actions such as verbal outbursts and physical threats, as well as passive activities as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities” (Murray, 284). This type of behavior can create a hostile environment which will affect patient care, some consequences of disruptive behavior are suicide by nurses from depression, poor patient care, and nurses’ turnover rate which can lead to poor work performance, high nurse call-outs, hostility, which all can cause a sentinel event. These disruptive behaviors are often seen in many nursing units, preferably in the form of being sworn at, given the worst shifts, doctors talking down to nurses, nurses talking down to nurses and bullying other nurses, new nurses need to understand that this is not the norm and we need to be a part of the culture to make the change. OSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the worksite. It ranges from threats and verbal abuse to physical assaults and even homicide. Elizabeth Murray states that three common behaviors contribute to disruptive behavior, and that is lateral violence, incivility, and bullying. Disruptive behavior continues to happen within the workplace because “it can, because it has molded, and because it is left unchecked…another contributing factor is that nurses have been expected to cope with violence and accept abuse as part of the job” (Murray 286). How do we change the culture, according to Ron Savrin, “we need to change organizational culture; the question is what is the best way for this to happen. There is general agreement that leadership is responsible for effecting change — policies and procedures regarding disrespectful behavior that must be established and followed. Team members must be encouraged to report such behavior and feel protected from the consequences of reporting. All members of the team, without exception or variation, must be held accountable.”Rosemary Parse, California Baptist College of Nursing theorist, describes nursing in the past was commonly perceived to be a “profession closely related to medicine in the cure of human beings, but now it is justifying its claim as a scientific discipline with its unique frameworks and theories” (Parse., 2014 p. 1). Living the art of the humanbecoming “is living true presence” (Parse., 2014 p. 93). Parse said it best when she stated that each patient is like a “fingerprint in that it belongs to only one [individual] and while others coexist in the large journey of life, each lives his or her way on the journey” (Parse., 2014 p.93). When a nurse views a patient in such a manner, it makes for better patient care, and a better relationship because understanding where a patient comes from is important and to treat them, not their illness.According to the Healthcare Research and Quality (AHRQ), “TeamSTEPPS is an evidence-based framework to optimize team performance across the health care delivery system. TeamSTEPPS has five key principles. Based on team structure and four teachable-learnable skills: Communication, Leadership, Situation Monitoring, and Mutual Support. Encircling the four skills is the team structure of the patient care team, which represents not only the patient and direct caregivers but also those who play a supportive role within the health care delivery system” (AHRQ).AHRQ states the best approach to take is a constructive approach for managing and resolving conflict, there is an acronym that they use (DESC) Describe the specific situation or behavior, provide concrete date, Express how the situation makes you feel/you’re your concerns are, Suggest other alternatives and seek agreement, and Consequences should be clear in terms of impact on established team goals; strive for consensus. They also recommend using an assertive statement (CUS) I am Concerned, I am Uncomfortable, and this is a Safety issue when or if you feel that your point is not getting across it is best to take a different stance and utilize the chain of command. The American Nursing Association, states nurses create “an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect.”Change has to start somewhere, and what better place than with the new graduate nurse on combating disruptive behavior we have to make sure we know our facilities policy on such behavior, not everything in life is going to go our way and we are going to experience the bullying from the other nurse but until we stand up and say enough is enough and I refuse to work in such environment and state we will not tolerate this type of behavior, and not be afraid to say if it continues you will take action. The article, Challenges of Fresh Nursing Graduates During their Transition Period, discusses the challenges students experience during their transition into the role of RN. An RN is expected to be self-sufficient some think that you should stand on your own two feet as soon as you graduate, but it seems as if a lot of the older nurses forget where they came from that’s the whole purpose of a new grad position to where you shadow a nurse for a certain number of days depending on the facilities policy and during that time I think that its very important to build a good relationship with your coworkers. There will be times that the feeling of intimidation takes over and that is when the second-guessing comes into play, and not ask a senior nurse for help, but wouldn’t it be better to ask, and they say no than to not ask, and a patient suffers the consequences.Being a Christian and a nursing student I put Christ first and I know that as long as I am obedient to Christ, he will let no harm come to me as stated Deuteronomy 31:6 “Be strong and courageous. Do not be afraid or terrified because of them, for the LORD your God goes with you; he will never leave you nor forsake you”. As a child of God, I refuse to allow disruptive behavior to become part of my life as a nurse. After leaving from the military I suffer from PTSD, and it is a daily challenge for me, my anxiety and depression get the best of me sometimes, and I have to surrender to God because I cannot do it alone. I know there may be a time where I don’t see eye to eye with a coworker and that is ok, but I know at the end of the day it is something that is out of my control but never will I ever talk down, gossip, swear, or treat my coworkers disrespectful, because I don’t know what they are going through that day and they could just be having a bad day. Proverbs 2:11 states that “Discretion will protect you, and understanding will guard you.” So, if I feel that I am ever a victim of disruptive behavior I will immediately address the situation, and if it cannot be resolved I will utilize the chain of command, it states in John 14:27 “Peace I leave with you; my peace I give to you. Not as the world gives do I give to you. Let not your hearts be troubled, neither let them be afraid”. Christians, in general, have a responsibility to their patients as well as to humankind, we must treat one another the way we would want to be treated because it is all by the glory of God that we are where we are today. There is a verse in Luke 9:1-2, Jesus “called the twelve together and gave them power and authority over all demons and to cure diseases, and he sent them out to proclaim the kingdom of God and to heal.” As a nurse, we are the chosen ones to do Gods work, and he saw us through times when we did not think that we were going to make it, we just must put our trust in God and keep going and know that he will not let us fail or forsake us. By having a biblical worldview, it will make us better a nurse and see and pull us through if we struggle with disruptive behavior because we serve an awesome God. In conclusion, disruptive behavior cannot and should not exist in the medical field because there are too many consequences and most of all patients suffer, we as future nurse need to set an example for others to follow, so we must review our facilities policy on disruptive behavior and make sure it in affect and if not then we must take the next step to ensure that it is brought to someone’s attention before someone gets hurt or hurts themselves. It is essential that in the medical field that we have a biblical approach to these situations because we can do anything through Christ who strengthens us. ReferencesAmerican Nursing Association. Incivility, Bullying, and Workplace Violence. (2015, July 22). Retrieved from file:///C:/Users/sanma/Desktop/PosStat-Endorsed-ANA-Incivility-Bullying-Violence.pdfDeuteronomy 31.6 English Standard VersionJohn 14:27 English Standard VersionLeape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman‐Levitan S, Meyer GS, and Savin R. A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians. Acad Med. 2012; 87:845–852.Luke 9:1-2 English Standard VersionMurray, E. (2017). Nursing Leadership and Management for Patient Safety and Quality Care. Philadelphia, PA: F.A Davis Company.Occupational Safety and Health Administration. OSHA cites residential facility for exposing employees to workplace violence. (2016, July 9). Retrieved from https://www.osha.gov Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview. Pittsburgh, PA: Discovery International.Pocket Guide: TeamSTEPPS. Content last reviewed on January 2014. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.htmlProverbs 2:11 English Standard VersionWong, Julia S W et al. (2018). Challenges of fresh nursing graduates during their transition period. Journal of Nursing Education and Practice. 8. 30. 10.5430/jnep.v8n6p30.
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