Assertiveness training to prevent verbal abuse in the OR - Home Study Program

After reading and studying the article on assertiveness training to prevent verbal abuse in the OR, the nurse will be able to

1. identify the dimensions of verbal abuse,

2. explain how episodes of abuse have evolved historically in the perioperative setting,

3. describe the effects of verbal abuse, and

4. discuss interventions that can be used to prevent and manage verbal abuse.

Verbal abuse is a common form of workplace violence in today's health care environment. Of 461 nurses surveyed in 1999, 94% had experienced some form of verbal abuse. (1)

DIMENSIONS OF VERBAL ABUSE

The term verbal abuse frequently is defined as communication perceived by a person to be a harsh, condemnatory attack, either professional or personal (Table 1). It may be conveyed with tone, manner, or nonverbal cues. (2) Abuse in the health care arena consists of two dimensions, horizontal and vertical abuse. Horizontal abuse is abuse directed between two equally ranked coworkers, such as between two nurses. Vertical abuse is use of inappropriate power toward an actual or perceived subordinate. Vertical abuse occurs when a surgeon directs abuse toward a nurse. A nurse directing abuse toward a subordinate nurse or coworker (eg, scrub technician) or directing inappropriate behavior toward a patient also are examples of vertical abuse. Vertical abuse directed from the surgeon toward a nurse usually is done in the presence of others. Vertical abuse between two nurses, on the other hand, usually occurs in a private area.

A recent study conducted in Veteran's Health Administration hospitals noted that more than 50% of the physicians were unaware of the effects verbal abuse had on nurses. (3) Other recent studies have shown a high incidence of verbal abuse directed at perioperative nurses by surgeons. (4-7)

HISTORICAL PERSPECTIVE

The perioperative setting can be very stressful. A surgical team consists of the anesthesia care provider, the surgeon, an RN first assistant (RNFA) or a resident physician, a scrub person, and a circulating nurse. With the exception of the anesthesia care provider and the circulating nurse, team members must remain within the sterile area and, therefore, are unable to leave when verbal abuse occurs. The anesthesia care provider continuously monitors the patient during the procedure and is required to be in the OR during the entire procedure. Although the circulating nurse may leave the OR to retrieve supplies or medications, he or she must return quickly, and therefore, is almost as vulnerable to abuse as team members confined to the sterile area. The victims of abuse must stay and listen to the abusive comments until someone can provide relief. If relief can be obtained at all, it may be a matter of minutes or hours, particularly if the individual is part of an on-call team.

In the past, the perioperative setting allowed for some laxity with jokes, remarks, or pranks. This was accepted in the perioperative cul0are as a method of stress reduction. Problems occurred, however, when the behavior was unwelcome by staff members or if the behaviors included lewd remarks or sexual innuendos. These remarks could spread through gossip to other staff members and could create an environment of unrest and decreased trust. (1) This laxity has become increasingly less acceptable in the current health care environment.

EFFECTS OF ABUSE