Recognizing and Reducing Horizontal Violence Among Nurses at a Veterans Affairs Medical Center: A Cognitive Rehearsal Quality Improvement Project

摘要

Aim: The aim of this project was to help nurses at the Veterans Affairs Medical Center (VAMC) in Durham, North Carolina recognize and reduce horizontal violence in the workplace using an evidence-based educational session with a cognitive rehearsal technique.;Background: Mounting evidence compiled over the last two decades has established the existence of horizontal violence in the nursing profession. Further, horizontal violence continues to be an ongoing challenge despite substantial evidence that it can negatively affect a nurse's quality of life and compromise patient safety.;Methods: VAMC staff nurses attended two educational sessions (one hour in total) of training about ways to combat horizontal violence and to learn cognitive rehearsal techniques. The first session presented the theoretical concept of horizontal violence, discussed how horizontal violence affects nurses, and included discussion of nurses' responses to three open-ended questions. In the second educational session, participants learned about and practiced appropriate responses to the most common forms of horizontal violence through cognitive rehearsal, an interactive role-playing experience. At the end of the session, each participant was given cue cards that each stated a common form of horizontal violence and its appropriate response. A follow-up survey was conducted at the end of the session to determine participants' satisfaction with and perspectives about the educational intervention.;Results: Participants reported that participation in the educational session (1) increased their awareness of horizontal violence and (2) enabled them to identify at least three strategies to combat horizontal violence. Further, participants recommended that nursing colleagues would greatly benefit from the training.;Conclusion: This educational session targeted the negative effects of horizontal violence and used an evidenced-based cognitive rehearsal technique to increase awareness of interventions to offset negative behaviors associated with horizontal violence. Raising awareness and labeling this problem are the first steps in reducing the occurrence of horizontal violence among nurses. These initial steps establish horizontal violence as a legitimate problem and hopefully will set in motion an action plan for change at the VAMC.