Workplace Violence as a Phenomenon

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Introduction

South Africa as a country is known locally and internationally to be a violent society. This violence permeates every aspect of society. Violence on the roads in the guise of road rage and bullying at schools receives much media coverage. The phenomenon of violence in the workplace as an academic and scientific concept is receiving increasing attention but as a phenomenon is still largely misunderstood. The increasing attention is largely due to the fact that certain scholars and academics around the world have conducted a number of research studies highlighting the plight of the bullied worker, which has escalated awareness of the issues, mainly in the developed world. However, in developing countries like South Africa, the phenomenon and incidents have mostly gone unrecorded. Nguluwe, Havenga & Sengane (2014:71) noted that nurses explained the effects of violence as physical pain and emotional distress and it can be concluded that these experiences of violence have a negative effect on their mental health. Di Martino (2002:2) noted that “up to recently, no national study on the health sector has been made available, no comparative analysis has been developed, and very limited coverage has been provided for the developing world”. His comments on the developing world included the situation in South Africa. Since 2002 and Di Martino’s pronouncements there have been a number of studies on health care workers specifically and workplace violence experienced by health care workers. Some of the studies noted are Nguluwe et al (2014) who examined workplace violence against nurses in a psychiatric setting, Kennedy & Julie (2013) who studied workplace violence against nurses in a trauma and emergency department in SA and Gillespie et al (2010) who studied workplace violence in a paediatric emergency department .
The phenomenon of workplace violence is thus at best known but requiring more examination. There is some national research on workplace violence in the health care sector. In a study conducted by Steinman (2003:21) in the greater Johannesburg Metropolitan Region, 61% of all health care workers experienced at least one incident of workplace violence in the year prior to the study. Howerthorn Child & Mentes (2010:89) indicated that nurses working in emergency departments and psychiatric wards are the most vulnerable. Because psychological effects cannot be seen and are not visible to by the naked eye, it is often easier to ignore them or remain unaware of them. The symptoms of psychological distress may vary from person to person and may take the form of, inter alia, sleep disturbance, nightmares, anxiety, tearfulness, anger, shock or depression. Cooper (2001:vi) has expounded on factors that contribute to the prevalence of violence in the healthcare sector workplace, viz. it is a female-dominated industry exposed to patients suffering from mental illness or alcohol or drug abuse. Poor environmental factors, such as lighting, have also been noted. The fact that healthcare facilities are often situated in communities rife with gangs and violence which inevitably spills over into the facility has also been noted. Many South African nurses, lured by promises of better incentives and working conditions, are leaving the country to work in the developed world. In addition, many other nurses are leaving the public sector to work in the private sector. The remaining cadre of nurses is consequently burdened with high caseloads, work overload and poor working conditions, which lead inevitably to burnout. The health sector environment is thus definitely conducive to the eruption of violence The health sector is beset by many problems – viz. high attrition rates, high staff turnover, high burnout rates and poor morale, to name but a few. These problems all have global relevance and are not uniquely South African. In a behavioural risk audit conducted as part of the EAP, the following facts on the Yusuf Dadoo Hospital emerged, the chosen site for the empirical study. Conflict at work was reported to be high or very high by one in three respondents.
This was related to reports of poor communication. This situation is extremely conducive to the eruption of workplace violence (ICAS Behavioural Risk Management Report, 2005). Definitely not to be underestimated are the socio-economic realities of life in developing countries. In a country like South Africa, with its high levels of violence, one could almost argue that violence has been normalised, which results in an attitude that seeks to minimise the incidence of violence. Steinman (2003:4) introduces the concept of a “threshold”, which suggests an upper limit or “acceptability level” of workplace violence and suggests that this acceptability level is dependent on legal, cultural, religious, emotional, social and political factors. The health care sector in South Africa, being but a microcosm of a violent society is thus a sector which is ripe for workplace violence to erupt. Cilliers (2012:7) reports on how victims of workplace violence expressed their feelings in response to the incident/s. They described exhaustion, being worn down, confusion, isolation, hopelessness and worthlessness. Some employees reported feeling incompetent or stripped of their worth and even acute symptoms of learned helplessness.
The very definition of workplace violence must be considered before embarking on any research or application models. Leather (2001:8), has highlighted the fact that the meaning of workplace violence is embedded in different socio-political realities, which gives rise to the nature and character of the problem itself. What constitutes violence? What is normal and what is abnormal? In a country such as South Africa, where violence levels are high and are virtually part of daily life, it is easy to minimise the issues of workplace violence and adopt a cavalier attitude. Such an attitude would perceive such violence as part of the daily reality of life in a society that has learned to cope with and adjust to abnormally high levels of violence. Given this, there are some who insist on a very restricted, narrow definition of workplace violence (Kraus, Blander & McArthur, 1995: 355-379), but others who would use a far broader definition (WHO, 2002:30). Cowman& Bowers (2008:1346) suggest that an accurate account of workplace violence is unavailable as it is defined inconsistently, inadequately documented, underreported and normalised.
The definition used is thus quite important. Because of the processes preceding this study, which relate to the management of violence in the workplace in the Gauteng Department of Health, with Dr Steinman introducing the concept a few years earlier as part of a research project, consistency was maintained and the WHO definition was once again used, viz. “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation” (WHO Publication, 2002:30). A broader definition of workplace violence certainly allows for a more holistic view of the issues and components to be considered, while a limited definition offers certain restrictions that may hamper a fuller exploration of the phenomenon of workplace violence.
For this reason, the researcher favoured a broader, more comprehensive definition. The broader definition does not limit the study, but explores both psychological and physical violence. It also includes patient- on-staff and staff-on-staff violence. A broader definition has thus been favoured and will be used in this study. Organisational factors contributing to workplace violence have been analysed extensively in a study conducted by Grubb, Roberts, Swanson, Burnfield and Childress (2005:37-59). Based on results from a nationally representative Sample of USA companies, this study found that bullying is more prevalent in larger companies and in not-for-profit companies, a finding the writers Say is consistent with the European literature. They postulated that providing services to the public allows more opportunity for interpersonal conflict. They also found that bullying was more likely to be reported in unionised companies, as this environment may both increase awareness levels and provide mechanisms for lodging complaints. They further noted that companies reporting incivility were more likely to have monthly team meetings, which, if held frequently, provide more opportunities for interpersonal conflict.

Table of contents :

• Declaration
• Acknowledgements
• Table of Contents
• List of Figures
• List of Tables
• Acronyms and Abbreviations
• Summary
• CHAPTER 1: General Orientation to the Study
  • 1.1. Introduction
  • 1.2. Theoretical Framework
  • 1.3. Problem Formulation
    • 1.3.1. Problem definition
    • 1.3.2. Extent of the problem
    • 1.3.3. Impact of the problem
  • 1.4. Goal and objectives of the Study
    • 1.4.1. Goal of the study
    • 1.4.2. Objectives of the study
  • 1.5. Research approach
    • 1.5.1. Hypothesis
    • 1.5.2. Selection of research approach
    • 1.5.3 Theoretical back- up for the type of research approaches
    • 1.5.4 Motivation for choice of type of research
  • 1.6. Type of research
    • 1.6.1. Theoretical back-up for the type of research
    • 1.6.2. Motivation for choice of type of research
  • 1.7. Research Design and Methodology
    • 1.7.1. Research Design
      • 1.7.1.1. The Nature of Research Design
      • 1.7.1.2. Choice of design
    • 1.7.2. Data Collection
    • 1.7.3. Data Analysis
  • 1.8. Pilot Study
    • 1.8.1. Feasibility of the Study
    • 1.8.2. Permission from authorities
    • 1.8.3. Availability of resources
    • 1.8.4. Testing of the data-collection instrument
  • 1.9. Description of the research population, sample and sampling method
    • 1.9.1. Research population
    • 1.9.2. Sampling method
    • 1.9.3. Size of the sample
  • 1.10. Ethical issues
    • 1.10.1. Informed consent and voluntary participation
    • 1.10.2. Avoidance of harm
    • 1.10.3. Cooperation with contributors
    • 1.10.4. Anonymity and confidentiality
    • 1.10.5. Special population and new inequalities
    • 1.10.6. Actions and competence of researcher
    • 1.10.7. Deception of respondents
    • 1.10.8. Release or publication of findings
    • 1.10.9. Debriefing of respondents
  • 1.11. Definition of key concepts
    • 1.11.1. Types of violence
  • 1.12. Limitations of the study
• CHAPTER 2: Workplace Violence as a Phenomenon
  • 2.1. Introduction
  • 2.2. Definitions of Workplace Violence
  • 2.3. Workplace Violence as a phenomenon
  • 2.4. The prevalence or occurrence of Workplace Violence
  • 2.5. Violence in the Healthcare Sector
    • 2.5.1. Situational factors
  • 2.6. Factors contributing to Workplace Violence
    • 2.6.1. Nurses as a group
    • 2.6.2. Gender and Patriarchy
    • 2.6.3. Environmental factors
    • 2.6.4. Organizational climate
  • 2.7. Profile of the Perpetrator
    • 2.7.1. Lack of a typical profile
    • 2.7.2. Victim-bully relationship
  • 2.8. Profile of the victim
    • 2.8.1. Victim-organization Dyad
    • 2.8.2. Gender of the victim
    • 2.8.3. Age of the victim
    • 2.8.4. Uniforms
    • 2.8.5. Health of victims
    • 2.8.6. Personality of victim
  • 2.9. Consequences of Bullying
    • 2.9.1. Incident not viewed seriously
    • 2.9.2. Victims considered trouble-makers
    • 2.9.3. Victim-bully relationship
    • 2.9.4. The cost of Workplace Violence
    • 2.9.5. Post-traumatic reactions
    • 2.9.6. Stress, Workplace Violence and bullying
  • 2.10. Prevention of Workplace Violence
    • 2.10.1. Training
    • 2.10.2. An integrated approach
    • 2.10.3. Multi-dimensional approach
    • 2.10.4. Strategies
    • 2.10.5. Research
    • 2.10.6. Evaluation of training programmes
    • 2.10.7 Programme context
  • 2.11. Conclusion to the chapter
• CHAPTER 3: Literature Review on the Management of Violence in the Workplace Programmes
  • 3.1. Introduction
  • 3.2. Research challenges
  • 3.3. Reporting
  • 3.4. Long-Term or short-Term measures on the management of violence in the workplace programmes
  • 3.5. Security measures
  • 3.6. Policies
  • 3.7. Country Studies’ Recommendations
  • 3.8. Effective Workplace Violence Programmes
    • 3.8.1. Leadership
    • 3.8.2. Recruitment
    • 3.8.3. Selection
    • 3.8.4. Training
    • 3.8.5. Performance appraisal
    • 3.8.6. Discipline
    • 3.8.7. Environmental factors
  • 3.9. Training as an intervention strategy
    • 3.10. The role of EAPs in the management of WPV
    • 3.10.1. Role in early preventions efforts
    • 3.10.2. Participation on an incident response team
    • 3.10.3. Follow-up to a violent incident
    • 3.10.4. Acting as consultants to management
    • 3.10.5. Guidelines for non-involvement
  • 3.11. EAP Core Technologies
  • 3.12. Conclusion of chapter
• CHAPTER 4: The Management of Violence Workplace Training Programme
  • 4.1. Introduction
  • 4.2. Background
  • 4.3. The Framework Guidelines for addressing WPV in the Health Care Sector
    • 4.3.1. Background, scope and definition of WPV
    • 4.3.2. General rights and responsibilities of
    • stakeholders/role-players
    • 4.3.3. Approaches of managing WPV
    • 4.3.4. Violence Recognition
    • 4.3.5. Violence Assessment
    • 4.3.6. Workplace Interventions
    • 4.3.7. Evaluation
  • 4.4. Logistics regarding the research project
    • 4.4.1. Permission to conclude the research project
    • 4.4.2. Stakeholder engagement
    • 4.4.3. Entry to the hospital
  • 4.5. Logistics regarding the presentation of the training programme for purposes of the specific study
    • 4.5.1. The Management of Violence in the Workplace Training Programme (VETO)
    • 4.5.2. About the Programme
    • 4.5.3. Vision of the Programme
    • 4.5.4. Mission of the Programme
    • 4.5.5. Values of the Programme
    • 4.5.6. Programme for the training
  • 4.6. Research phases, dates and sequence of events
  • 4.7. Conclusion to the chapter
• CHAPTER 5: Empirical Study on Workplace Violence and Management of Violence in the Workplace Training
  • 5.1. Introduction
  • 5.2. The Survey
  • 5.3. Pre-Test and Post-Test phase
  • 5.4. Qualitative interviews
  • 5.5. Data Analysis
    • 5.5.1. Phase
    • 5.5.2. Phase 2: Pre-Test and Post-Test
    • 5.5.3. Phase 2: Qualitative phase
  • 5.6. Sampling
  • 5.6.1. The population
  • 5.6.2. Sampling
  • 5.7. Analysis of the survey data
  • 5.7.1. Survey response rate
  • 5.7.2. Exposure to WPV
  • 5.7.3a. Gender vulnerability to WPV
  • 5.7.3b. Multiple incidents of WPV
  • 5.7.4. Gender vulnerability to multiple incidents of WPV
  • 5.7.5. Age and multiple incidents of WPV
  • 5.7.6. Professions most exposed to WPV
  • 5.7.7a. Seniority of position and exposure to WPV
  • 5.7.7b. Seniority of position and extent of Workplace Violence incident/s
  • 5.7.8a. Unit/Ward the employee works in
  • 5.7.8b. Unit/Ward and exposure to WPV
  • 5.7.9. Types of WPV
  • 5.7.10. The perpetrator of WPV
  • 5.7.11. The location of the incident/s
  • 5.7.12. Post-incident action
  • 5.7.13. Deterrents to reporting WPV
  • 5.7.14. Emotional responses to incidents of WPV
  • 5.7.15. Awareness of the phenomenon WPV
  • 5.7.16. Post-traumatic symptoms following incidents of WPV
  • 5.7.17. Strategies to address WPV
  • 5.8. Analysis of the Pre-Test, Post-Test and shifts from the Pre-Test to the Post-Test
  • 5.8.1. Introduction
  • 5.8.2. Exposure to WPV and experience
    • 5.8.2.1. Gender vulnerability to WPV
    • 5.8.2.2. Workplace Violence and professional groups
    • 5.8.2.3. Workplace Violence and seniority
    • 5.8.2.4. Workplace Violence and type of unit/ward
  • 5.8.4.5a. Age and WPV
  • 5.8.2.5b. Age and exposure to WPV
  • 5.8.2.6. WPV as related to staff contact with the public
  • 5.8.2.7. Multiple incidents of WPV
  • 5.8.2.8. Types of WPV
  • 5.8.2.9. The perpetrator
    • 5.8.2.10. Location of the incident/s
    • 5.8.2.11. Response to the incident/s
    • 5.8.2.12. Reasons for not taking action
    • 5.8.2.13. Emotion after the incident/s
    • 5.8.2.14. Awareness of WPV
    • 5.8.2.15. Symptoms after the incident/s
  • 5.8.3. Shift in attitude, belief and skills from Pre-Test to Post-Test
  • 5.8.3.1. The cost of WPV
    • 5.8.3.2. Verbal abuse
    • 5.8.3.3. WPV as a serious phenomenon
    • 5.8.3.4. Policy as a driver of reporting WPV
    • 5.8.3.5. Own behavior contributing to WPV
    • 5.8.3.6. Colleagues’ behaviour as a trigger of WPV
    • 5.8.3.7. Authority to combat WPV
  • 5.8.3.8. Belief in effectiveness of measures to combat WPV
  • 5.8.3.9. Belief in individual contributions making a difference
  • 5.8.3.10. Responsibility to manage WPV
  • 5.8.3.11. Healthcare Sector vulnerability
  • 5.8.3.12. Factors contributing to WPV
  • 5.8.3.13. Attitude towards individual contributions
  • 5.8.3.14. Training on WPV was useful
  • 5.8.3.15. Personal responsibility to manage WPV
  • 5.9. Qualitative phase
  • 5.9.1. Introduction
  • 5.9.2. Participant Profile
  • 5.9.2.1. How has the training influenced your thinking on the phenomenon of WPV? (Question 1)
  • 5.9.2.2. Do you think that the training has influenced the situation at the hospital? (Question 3)
  • 5.9.2.3. Have the action plans decided upon, been implemented since the training? (Question 4)
  • 5.9.2.4. What has your contribution been to ensuring that these plans are implemented? (Question 5)
  • 5.9.2.5. Do you believe that the workplace training programme has contributed towards changing people’s attitudes, knowledge and skills around these issues? (Question 6)
  • 5.9.2.6. Have the reporting mechanisms improved as a result of the training and is there more confidence in the process? (Question 7)
  • 5.9.2.7. What would you recommend to strengthen the training programme and its implementation? (Question 8)
  • 5.9.2.8. Has the training programme assisted you in dealing with the incident we spoke about? Please discuss (Question 9)
  • 5.8.2.9. General comments or recommendations (Question 10)
  • 5.9.2.10. Conclusion of the chapter
  • 5.10. Conclusion of the Chapter
• CHAPTER 6: Key findings, conclusions and recommendations
  • 6.1. Introduction
  • 6.2. Chapter 1: General orientation to the study
  • 6.2.1. Summary
  • 6.2.2. Conclusions
  • 6.2.3. Recommendations
  • 6.3. Chapter 2: Workplace Violence as a Phenomenon
  • 6.3.1. Summary
  • 6.3.2. Conclusions
  • 6.3.3. Recommendations
  • 6.4. Chapter 3: Literature Review on the Management of Violence in the Workplace Programmes
  • 6.4.1. Summary
  • 6.4.2. Conclusions
  • 6.4.3. Recommendations
  • 6.5. Chapter 4: The Management of Violence Workplace Training Programme
  • 6.5.1. Summary
  • 6.5.2. Conclusions
  • 6.5.3. Recommendations
  • 6.6. Chapter 5: Empirical Study on Workplace Violence Management of Violence in the Workplace Training
  • 6.6.1. Summary: Survey
  • 6.6.2. Conclusions
  • 6.6.3. Recommendations
  • 6.6.4. Summary: Pre-Test and Post-Test
  • 6.6.5. Conclusions
  • 6.6.6. Recommendations
  • 6.6.7. Summary: Interviews
  • 6.6.8. Conclusions
  • 6.6.9. Recommendations
  • 6.7. Comparison between the Quantitative and Qualitative Empirical results
  • 6.8. Evaluation of the Goals and Objectives of the Study
  • 6.8.1. Summary
  • 6.8.2. Conclusions
  • 6.9. Evaluation of the Research Problem and the Hypothesis
  • 6.9.1. Summary
  • 6.9.2. Conclusions
  • 6.10. Recommendations for Future Research
  • 6.11. Conclusion of the chapter
  • REFERENCES

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