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In the article, “Nurse exposure to
physical and nonphysical violence, bullying, and sexual harassment”, Spector et
al., 2014 highlighted a national study in Canada that discovered
violence-related worker’s compensation board (WCB) claims was the second
highest of all occupations for healthcare aides, and sixth highest was for
nurses. When a nurse experiences any form of violence, it affects his/her
ability to provide a safe, compassionate, competent and ethical care to the
patient which is one of the ethical values laid out by Canadian Nurses Association (CNA). Violence experienced by one
nurse could be different from violence that is experienced by another e.g.
physical; nonphysical such as lateral and horizontal violence; bullying; and
sexual harassment. Spector et al., 2014 stated that this is dependent on the
settings or the department that a nurse practices for example, hospital,
nursing home, and psychiatric facility while the sources of the violence are
patient, patient’s family or friends, other professionals such as physicians,
and other nurses. The expectation of the profession is to practice quality in a
safe environment, show compassion as well as provide quality care to both the
patients and the colleagues, and demonstrate competence these are ethical

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The purpose of this paper is to discuss the first of the seven ethical values
which is by “providing safe, compassionate, competent and ethical care” (CNA,
2008, p. 3) as it relates to the Canadian Nurses
Association code of ethics in the context of a case scenario, I will describe the
value as it relates to professionalism and nursing practice and conclude by
sharing some suggestions for reducing the challenges that nurses face while
striving to achieve competence and provide therapeutic care within a multidisciplinary team.



Gordon in a hostile and unsafe


Gordon started working in the emergency
unit in the hospital for just one year. Gordon went to a physician to double
check the dosage of a medication that was ordered for his patient. The reason
for his enquiry was to be sure that the dose was meant for the patient so he
would rule out medication error. The physician paused, stared and frowned at
him before asking “and when did you complete nursing school?” She walked away
without answering his question. Gordon felt that his enquiry should not have caused
him to be disrespected so he went back to his station, consulted with his
charge nurse, checked the medication guide that was provided at the hospital
and documented the incidence before administering the medication.

Later, Gordon was assessing Charlie, a
young man that was just brought into the emergency unit for his motorcycle
accident. Charlie required the cleaning of his skin from the cuts and bruises
that resulted from the accident. Gordon explained to Charlie that it was going
to be an uncomfortable procedure, then he provided Charlie some analgesic but
he refused. Gordon was just starting the assessment when Charlie looked at him
strangely, cursed and then pushed him in a way the he was almost knocked off
his feet. Gordon advised Charlie that his actions were unacceptable. He left
the stall in order to seek assistance from other nurses. This was the third
time Gordon was being hit by his patient in one week. He recalled that exposure
to physical and nonphysical forms of violence against nurses in his department
needed to be addressed as work was becoming a pressure for him.

Supporting Each
other to Create a Safe Workplace

From the case highlighted above, issues
of ethics, safety and competence is continuously increasing among healthcare
providers. This has therefore been labeled lateral and horizontal violence
which is unsafe and inhibit compassionate ethical practices. According to
Brophy, et al., 2017, there were minimal research released about ethics and
violence against nurses before year 2000. There are different postulations
about why lateral, horizontal violence, bullying and other disruptive
behaviours, the most popular suggests that nurses transfer frustrations to
other nurses of less power or from physician to nurses as a way of dealing with
their inability and pressure (Lachman, 2014). The nursing code of ethics states
that as part of a moral community, “all nurses acknowledge their responsibility
to contribute to positive, healthy work environments” (CNA, 2008, p.21, item

Gordon witnessed two incidences in the
case described. His first experience can be described as bullying. Bullying is
more than the indecisive disrespect to an individual, bullying is intentional
and it is the thoughtful target at a particular individual or group for
example, healthcare aides, novice nurses (Lachman, 2014). Gordon retracted, he
felt embarrassed and disrespected although, and he still needed to provide the
patient with the medication. He was caught in the state of conflict, while the
necessity was needed that is, to provide a safe, compassionate, competent and
ethical care to his patient; his self-control was to be at the peak so that
patient care will override the retrograde he was going through. The question
here is that, what should Gordon do when the physician was unethical and unprofessional?
One suggestion is that, Gordon would be expected to express his concerns with
the physician or inform his charge nurse about the issue so that she would take
the matter to the physician as a way to resolving the issue since bullying can
be interpreted as an unethical practice. This statement is supported by CNA,
2008, “Nurses question and intervene to address unsafe, non-compassionate,
unethical or incompetent practice or conditions that interfere with their
ability to provide safe, compassionate, competent and ethical care to those to
whom they are providing care, and they support those who do the same” (p. 9,
item 4).

Supporting the
Patient while Providing Competent and Ethical Care

From the case, Gordon’s second
experience can be described as a physical violence. Brophy et al., 2014 cited
Banerjee et al. that Canadian healthcare workers in long term facilities are
predisposed six times more physical violence than those workers in Scandinavian
countries. Nurses in emergency departments, psychiatric units, and dementia
units are the most at risk of having injuries. According to Brophy et al., they
require time of work as a result of violence four times more than any other
form of injury. This implies that, the rate at which patients assault nurses is
growing and the effect on nurses’ provision of competent and ethical care is
questionable. How would a nurse demonstrate and provide a safe, compassionate, competent
and ethical care when it is not be appreciated by the respondent?

What would Gordon do as he provides
safe, compassionate, competent and ethical care to a violent patient? According
to CNA, 2008, responsibilities “…when violence cannot be anticipated or
prevented, nurses take action to minimize risk to protect others and themselves”
(p. 9, item 10). The violence against Gordon was unanticipated and the risk was
high. Patients, patient family members and friends assault and violence against
nurses are generating a significant attention (Spector, et al., 2014). Most
physical violence arise from patients and their families. In the instance that
the violence is anticipated, the nurse will prevent or minimize it by assessing
the environment, calling for collaboration with other nurses and ensuring a
preventive approach but when the incidence is not anticipated, reflection after
the incidence is done by a superior nurse. The approach is to prevent the
occurrence in the future while the authority is informed about the policy
measures to ensuring a safe, and ethical environment when nurses deliver the
compassionate and competent care.

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