Assigment .Apa seven . All instructions attached.

Topic 1: Workplace Violence and Incivility in Healthcare

Alex De Cardenas

Florida National University

Decision Making-DAX-DL01

Dr. Nora Hernandez-Pupomay

May 21, 2026

Topic 1: Workplace Violence and Incivility in Healthcare

I. Introduction

A. Background Information

· Worldwide, most healthcare professionals are exposed to workplace violence (WPV), and nurses make up the largest group of healthcare professionals exposed to WPV (Al-Qadi, 2021).

· WPV includes aspects of physical, verbal, sexual, and psychological abuse by the patient, visitors, or colleagues (Eshah et al., 2024).

· Incivility and horizontal bullying have been identified as a risk factors for more serious forms of violence; both factors impact on burnout, turnover and professional identity erosion.

B. Statement of the Problem

· Even though there is a very high prevalence, WPV is grossly underreported, in some instances as a result of nurses' normalisation of violence, especially non-physical violence, (Zolkefli, 2024).

· WPV is directly associated with nurse burnout, post-traumatic stress, intent to leave the profession, and the poorness of patient safety outcomes (Eshah et al., 2024).

· Bedside Nurses, Nurse Managers and APNs all have unique aspects of this issue to address, which call for different targeted and evidence-informed decision-making responses.

C. Thesis Statement

· The issue of workplace violence/incivility in healthcare is a widespread, underreported and growing problem that puts the safety and well-being of nurses at risk at all levels of practice. Bedside nurses, nurse managers, and advanced practice nurses all have unique but complementary skills to help prevent, respond to, and mitigate workplace violence, and a combined, multi-level strategy is vital to achieving long-term systemic change using the Clinical Judgment Model, Shared Decision-Making, and Transformational Leadership decision-making frameworks.

II. Literature Review / Background

A. Overview of Existing Research

· The concept analysis by Al-Qadi (2021) paves the ground for this paper, which was used to create an operational definition of WPV for nurses.

· Eshah et al. (2024) performed a thorough and systematic review of the literature, focusing on the factors that are the most crucial for prevalence and prevention of WPV: patient/visitor perpetration, mandatory education, and administrative support.

· Zolkefli (2024) states that nurse leaders' lack of action on non-physical WPV contributes to normalization and reminds nurse leaders to speak out against all types of workplace violence.

· In a qualitative study, Luca et al. (2024) discovered that nurse leaders were not adequately aware and trained in identifying bullying and lateral violence, which was a key area that needed to be developed.

· Johnstone et al. (2024) found that ambulatory nursing leaders who utilized a cross-functional and empathetic approach greatly progressed WPV prevention program outcomes.

B. Key Theories and Decision-Making Models (Minimum 2 Required)

· Noticing, interpreting, responding, reflecting — the Clinical Judgement Model (Tanner, 2006 / NCSBN) can be applied directly to de-escalation, incident recognition and post-incident debriefing; applicable to bedside nurses.

· Shared Decision-Making (SDM) Model: Favours staff participation in policy development; enables WPV prevention planning at the unit and organisational level to be collaborative.

· Transformational Leadership Model: Supports nurse managers and APNs to facilitate culture change, create zero-tolerance environments and foster accountability throughout the nursing continuum.

III. Main Body / Discussion

A. Section One – Topic Analysis and Context

· Identify WPV type (criminal intent, patient/visitor perpetrated, worker-on-worker / “lateral violence”, personal relationship-based).

· Describe the ways that incivility, horizontal bullying and structural normalization of violence contribute to environments where escalation is not addressed.

· Discuss organizational, cultural and systemic antecedents, including staffing deficiencies, reporting deficiencies, lack of staff accountability, and the absence of de-escalation training.

· The author supports his work with a number of concepts and literature reviews that are presented in the book, for example: Al-Qadi (2021) concept analysis, Eshah et al. (2024) literature review.

B. Section Two – Comparative Analysis of Decision-Making Approaches Across Nursing Levels

· Bedside / Staff Nurse — Clinical Judgment Model: Nurses notice the cues for escalation early, interpret the risk level, respond using de-escalation techniques, call for assistance and reflect through post-incident debriefs and reporting. Also, SDM: bedside nurses are involved in the unit level WPV task forces.

· Nurse Manager — Transformational Leadership: Leaders lead a shift away from normalization to zero tolerance, ensure that the reporting process is followed, create psychological safety for reporting, encourage support for staff through programs and services, and promote a change in culture (Zolkefli, 2024; Luca et al., 2024).

· APNs work collaboratively with multiple disciplines and hospital leadership to develop and assess system-wide initiatives to prevent WPV, champion legislation to protect APNs, and ensure institutional policy is informed by the best evidence (Johnstone et al., 2024).

C. Section Three – Application and Implications

· The implementation of a WPV task force based on SDM principles; mandatory de-escalation and bystander-intervention training based on SDM principles, Clinical Judgement Model; and Zero-tolerance culture with Transformational Leadership at all levels of the system.

· Strengthened nurse retention, mental health, decreased incivility, greater interdisciplinary trust, safer patient environments, and culture shift away from normalization.

· Constraints: The strong underreporting culture; the institutional resistance to policy changes; time and resource limitations for implementation training; staff fear of reprisals.

· Recommendations: Anonymous electronic reporting systems, mandatory WPV education at orientation and annually, peer-support and resilience programs, consistent enforcement of zero-tolerance policies from leadership.

IV. Conclusion

A. Summary of Key Points

· WPV is a multi-level crisis that requires a multi-stakeholder approach from bedside nurses, nurse managers, and APNs/CNOs.

· At each level of nursing practice, there are three decision-making models: Clinical Judgment, Shared Decision-Making, and Transformational Leadership.

· A culture of silence and normalization is the greatest barrier; leadership accountability is the most powerful lever for change.

B. Implications and Next Steps

1. The final paper will combine information from all sources reviewed to identify the most effective model for decision-making, then support the rationale with comparative analysis and determine a funding source for implementing a WPV prevention project (HRSA Nurse Workforce Development grant program or Sigma Theta Tau International research grants).

V. Preliminary References

Al-Qadi, M. M. (2021). Workplace violence in nursing: A concept analysis. Journal of Occupational Health, 63(1), e12226. https://doi.org/10.1002/1348-9585.12226

Eshah, N., Al Jabri, O. J., Aljboor, M. A., Abdalrahim, A., ALBashtawy, M., Alkhawaldeh, A., Saifan, A., Ayed, A., & Rayan, A. (2024). Workplace violence against healthcare workers: A literature review. SAGE Open Nursing, 10, 1–12. https://doi.org/10.1177/23779608241258029

Johnstone, C., Stanek, C., & Lopez, A. (2024). Ambulatory nursing leadership development of a workplace violence prevention model employing direct experience, patient empathy, and cross-functional team partnerships. Nurse Leader, 22(1), 55–60. https://doi.org/10.1016/j.mnl.2023.10.012

Luca, C. E., Pezzoli, G., Kunz, S., & Bianchi, M. (2024). Nursing leaders' knowledge and awareness of bullying and lateral violence: A qualitative study. SAGE Open Nursing, 10, Article 23779608241274210. https://doi.org/10.1177/23779608241274210

Zolkefli, Y. (2024). Nurse leader's role in addressing workplace violence. SAGE Open Nursing, 10, Article 23779608241275853. https://doi.org/10.1177/23779608241275853

Decision Making-DAX-DL01 Nora Hernandez-Pupo

Decision Making Process Paper Due

6 pages

Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting with DOI

Decision-Making Process Paper 

Instructions

In this assignment, you will be writing a 6–8-page paper identifying [ maximum page limit is 8 pages- do not exceed as it will incur a penalty], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic  MUST BE APPROVED  by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic. You are required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

5. Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting. 

Please see sample APA 7 paper- DO NOT use an Abstract.

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Details & Information

Topic 1: Workplace Violence and Incivility in Healthcare

Alex De Cardenas

Florida National University

Decision Making-DAX-DL01

Dr. Nora Hernandez-Pupomay

May 21, 2026

Topic 1: Workplace Violence and Incivility in Healthcare

I. Introduction

A. Background Information

· Worldwide, most healthcare professionals are exposed to workplace violence (WPV), and nurses make up the largest group of healthcare professionals exposed to WPV (Al-Qadi, 2021).

· WPV includes aspects of physical, verbal, sexual, and psychological abuse by the patient, visitors, or colleagues (Eshah et al., 2024).

· Incivility and horizontal bullying have been identified as a risk factors for more serious forms of violence; both factors impact on burnout, turnover and professional identity erosion.

B. Statement of the Problem

· Even though there is a very high prevalence, WPV is grossly underreported, in some instances as a result of nurses' normalisation of violence, especially non-physical violence, (Zolkefli, 2024).

· WPV is directly associated with nurse burnout, post-traumatic stress, intent to leave the profession, and the poorness of patient safety outcomes (Eshah et al., 2024).

· Bedside Nurses, Nurse Managers and APNs all have unique aspects of this issue to address, which call for different targeted and evidence-informed decision-making responses.

C. Thesis Statement

· The issue of workplace violence/incivility in healthcare is a widespread, underreported and growing problem that puts the safety and well-being of nurses at risk at all levels of practice. Bedside nurses, nurse managers, and advanced practice nurses all have unique but complementary skills to help prevent, respond to, and mitigate workplace violence, and a combined, multi-level strategy is vital to achieving long-term systemic change using the Clinical Judgment Model, Shared Decision-Making, and Transformational Leadership decision-making frameworks.

II. Literature Review / Background

A. Overview of Existing Research

· The concept analysis by Al-Qadi (2021) paves the ground for this paper, which was used to create an operational definition of WPV for nurses.

· Eshah et al. (2024) performed a thorough and systematic review of the literature, focusing on the factors that are the most crucial for prevalence and prevention of WPV: patient/visitor perpetration, mandatory education, and administrative support.

· Zolkefli (2024) states that nurse leaders' lack of action on non-physical WPV contributes to normalization and reminds nurse leaders to speak out against all types of workplace violence.

· In a qualitative study, Luca et al. (2024) discovered that nurse leaders were not adequately aware and trained in identifying bullying and lateral violence, which was a key area that needed to be developed.

· Johnstone et al. (2024) found that ambulatory nursing leaders who utilized a cross-functional and empathetic approach greatly progressed WPV prevention program outcomes.

B. Key Theories and Decision-Making Models (Minimum 2 Required)

· Noticing, interpreting, responding, reflecting — the Clinical Judgement Model (Tanner, 2006 / NCSBN) can be applied directly to de-escalation, incident recognition and post-incident debriefing; applicable to bedside nurses.

· Shared Decision-Making (SDM) Model: Favours staff participation in policy development; enables WPV prevention planning at the unit and organisational level to be collaborative.

· Transformational Leadership Model: Supports nurse managers and APNs to facilitate culture change, create zero-tolerance environments and foster accountability throughout the nursing continuum.

III. Main Body / Discussion

A. Section One – Topic Analysis and Context

· Identify WPV type (criminal intent, patient/visitor perpetrated, worker-on-worker / “lateral violence”, personal relationship-based).

· Describe the ways that incivility, horizontal bullying and structural normalization of violence contribute to environments where escalation is not addressed.

· Discuss organizational, cultural and systemic antecedents, including staffing deficiencies, reporting deficiencies, lack of staff accountability, and the absence of de-escalation training.

· The author supports his work with a number of concepts and literature reviews that are presented in the book, for example: Al-Qadi (2021) concept analysis, Eshah et al. (2024) literature review.

B. Section Two – Comparative Analysis of Decision-Making Approaches Across Nursing Levels

· Bedside / Staff Nurse — Clinical Judgment Model: Nurses notice the cues for escalation early, interpret the risk level, respond using de-escalation techniques, call for assistance and reflect through post-incident debriefs and reporting. Also, SDM: bedside nurses are involved in the unit level WPV task forces.

· Nurse Manager — Transformational Leadership: Leaders lead a shift away from normalization to zero tolerance, ensure that the reporting process is followed, create psychological safety for reporting, encourage support for staff through programs and services, and promote a change in culture (Zolkefli, 2024; Luca et al., 2024).

· APNs work collaboratively with multiple disciplines and hospital leadership to develop and assess system-wide initiatives to prevent WPV, champion legislation to protect APNs, and ensure institutional policy is informed by the best evidence (Johnstone et al., 2024).

C. Section Three – Application and Implications

· The implementation of a WPV task force based on SDM principles; mandatory de-escalation and bystander-intervention training based on SDM principles, Clinical Judgement Model; and Zero-tolerance culture with Transformational Leadership at all levels of the system.

· Strengthened nurse retention, mental health, decreased incivility, greater interdisciplinary trust, safer patient environments, and culture shift away from normalization.

· Constraints: The strong underreporting culture; the institutional resistance to policy changes; time and resource limitations for implementation training; staff fear of reprisals.

· Recommendations: Anonymous electronic reporting systems, mandatory WPV education at orientation and annually, peer-support and resilience programs, consistent enforcement of zero-tolerance policies from leadership.

IV. Conclusion

A. Summary of Key Points

· WPV is a multi-level crisis that requires a multi-stakeholder approach from bedside nurses, nurse managers, and APNs/CNOs.

· At each level of nursing practice, there are three decision-making models: Clinical Judgment, Shared Decision-Making, and Transformational Leadership.

· A culture of silence and normalization is the greatest barrier; leadership accountability is the most powerful lever for change.

B. Implications and Next Steps

1. The final paper will combine information from all sources reviewed to identify the most effective model for decision-making, then support the rationale with comparative analysis and determine a funding source for implementing a WPV prevention project (HRSA Nurse Workforce Development grant program or Sigma Theta Tau International research grants).

V. Preliminary References

Al-Qadi, M. M. (2021). Workplace violence in nursing: A concept analysis. Journal of Occupational Health, 63(1), e12226. https://doi.org/10.1002/1348-9585.12226

Eshah, N., Al Jabri, O. J., Aljboor, M. A., Abdalrahim, A., ALBashtawy, M., Alkhawaldeh, A., Saifan, A., Ayed, A., & Rayan, A. (2024). Workplace violence against healthcare workers: A literature review. SAGE Open Nursing, 10, 1–12. https://doi.org/10.1177/23779608241258029

Johnstone, C., Stanek, C., & Lopez, A. (2024). Ambulatory nursing leadership development of a workplace violence prevention model employing direct experience, patient empathy, and cross-functional team partnerships. Nurse Leader, 22(1), 55–60. https://doi.org/10.1016/j.mnl.2023.10.012

Luca, C. E., Pezzoli, G., Kunz, S., & Bianchi, M. (2024). Nursing leaders' knowledge and awareness of bullying and lateral violence: A qualitative study. SAGE Open Nursing, 10, Article 23779608241274210. https://doi.org/10.1177/23779608241274210

Zolkefli, Y. (2024). Nurse leader's role in addressing workplace violence. SAGE Open Nursing, 10, Article 23779608241275853. https://doi.org/10.1177/23779608241275853