Assigment .Apa seven . All instructions attached.

Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare

Yailin Ramirez

Florida National University

Decision Making-DAX-DL01

Dr. Nora Hernandez-Pupo

May 21, 2026

Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare

I. Introduction

A. Background Information. In the healthcare setting, workplace violence (WPV) is defined by physical assault, threats, verbal harassment and incivility towards patients, families and healthcare professionals. Bedside nurses in acute/ inpatient settings have the highest rate of violence, which is disproportionately high for healthcare workers. Kafle et al. (2022) confirmed WPV as a sustained epidemic in the nursing profession; Ramzi et al. (2022) reported elevated prevalence all over the world during the COVID-19 pandemic; and Amin et al. (2024) reported high prevalence among the nurses in tertiary care hospitals with severe psychological impact on them.

B. Statement of the Problem. Normalization, fear of retaliation, and poor organization protocols are all responsible for the underreporting of WPV. The cascading effect of moral distress, burnout and turnover leads to dangerous staffing levels and lower patient safety. Luo et al. (2024) found that psychological violence had a significant effect on decreased job satisfaction, which in turn predicted turnover intention, while Musaed (2023) found that psychological violence led to nurse burnout, which consequently affected the quality of patient care.

C. Thesis Statement: Shared decision-making model, transformational leadership, and interventions aimed at building nursing resilience can be seen as a multi-disciplinary strategy to address workplace aggression and create a safe environment that will contribute to nurse safety, retention, and better patient outcomes.

II. Literature Review/Background

A. Overview of Existing Research. WPV causes moral distress and staffing shortages, affecting not only bedside nurses, but nurse leaders and advanced practice nurses as well. Boudreau and Rhéaume (2024) showed that work environment factors play significant mediating roles on adverse nurse outcomes, and Lim et al. (2023) showed that the inpatient psychiatric nurses might have experienced persistent aggression and complex emotional consequences which needed immediate systemic and therapeutic response.

B. Key Theories and Models.

1. Shared Decision-Making (SDM) Model. According to Lomborg et al. (2025), Shared Decision Making (SDM) model is a decision-making process involving nurse, patient, and family to come up with care decisions, behaviors, and safety.

2. Transformational Leadership Model. According to Ystaas et al. (2023), this will lead to improvement of the nursing working environment and patient's outcome because of the use of idealized influence, empowerment, and intellectual stimulation leading to collective vision.

3. Nursing Resilience Interventions. According to Henshall et al. (2020), these are some of the interventions that a nurse could adopt to build resilience, adaptive decision making, emotion regulation, and protection when faced with violence or stressful healthcare environment.

III. Main Body/Discussion

A. Section One

Topic Analysis and Context.

WPV varies by the nursing continuum. During high acuity interventions and basic care activities, bedside nurses face the direct aggression and incivility of patients (Lim et al., 2023). Nurse managers deal with staffing consequences, policy application and post incident debriefing. APN's support institutional policies, risk assessment systems based on evidence, and legislative advocacy at the macro-level to prevent.

B. Section Two

Comparative Analysis.

· Bedside/Staff Nurse. Nursing resilience interventions support nurses in becoming more aware of de-escalation behaviour in earlier stages (Henshall et al., 2020) and to learn how to de-escalate and self-protect. SDM supports patients and their families to draw boundaries along with forming relationships to deliver non-violent care.

· Nurse Leader/Manager. Transformational leadership helps achieve good implementation of a zero tolerance policy at the unit level, provides empowerment to staff through shared governance safety committees and security and training resources (Ystaas et al, 2023)

· Advanced Practice Nurse. SDM can help with the formulation of a full and person-centred evaluation of violence risks and planning around trauma-informed care (Lomborg et al., 2025). Transformational leadership can facilitate building an interprofessional coalition, organizational policy changes and engaging community stakeholders for systemic changes (Ystaas et al., 2023).

C. Section Three

Application, Implications, and Funding.

For continuity of prevention ecosystem: Behavioural resilience interventions safeguard the immediate safety; SDM strengthen therapeutic trust and adherence; transformational leadership reshapes the organization’s culture around psychological safety. Challenges include resource constraints, state level reporting differences and organizational resistance. It includes the following recommendations: Report incidents electronically in a private and confidential fashion, and standardize it within the organization; conduct a teacher debrief; provide organization-wide education and training; and explicitly model teacher leadership by senior leaders publicly demonstrating their commitment.

Funding Source: Through HRSA, as one of the programs under NEPQR, funding will be made available to implement a unit-based WPV prevention program comprising staff resilience training, environmental safety measures, and an electronic reporting mechanism that facilitates confidential reporting of infections (HRSA, 2024).

IV. Conclusion

A) Key Point Summary. Responses to WPV must be coordinated and addressed on the level of the vertical line, or vertical level. The frameworks cover different nursing roles and come together to support a comprehensive prevention approach – from individual coping to relationship care to systems re-design.

B. Implications & Next Steps. Transformational leadership as the most important systems level intervention supported by SDM and resiliency interventions at the direct-care levels will be emphasized focally within the final paper in order to propose evidence-based and sustainable solutions to workforce safety, nurse retention, assessable increases in patient quality and the improvement of organizational culture.

V. Preliminary References

Amin, R., Shah, S., Nawaz, N., Altaf, M., & Shehzadi, A. (2024). Prevalence and impact of workplace violence among nurses in tertiary care hospitals. Biological and Clinical Sciences Research Journal, 2024(1), 956. https://doi.org/10.54112/bcsrj.v2024i1.956

Boudreau, C., & Rhéaume, A. (2024). Impact of the work environment on nurse outcomes: A mediation analysis. Western Journal of Nursing Research, 46(3), 210–218. https://doi.org/10.1177/01939459241230369

Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories. Journal of Clinical Nursing, 29(19–20), 3597–3599. https://doi.org/10.1111/jocn.15276

Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review. Journal of Clinical and Translational Research, 8(5), 421–424.

Lim, Z. Y., Idris, D. R., Abdullah, H. M. A. L., & Omar, H. R. (2023). Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study. Archives of Psychiatric Nursing, 46, 83–90. https://doi.org/10.1016/j.apnu.2023.08.008

Lomborg, K., Finderup, J., Thorne, S., & Søndergaard, H. (2025). Shared decision making in nursing and advanced practice nursing. In Oxford textbook of shared decision making in healthcare (pp. 288–291). https://doi.org/10.1093/med/9780198897804.003.0057

Luo, Y., Zhang, M., Yu, S., Guan, X., Zhong, T., Wu, Q., & Li, Y. (2024). The impact of psychological violence in the workplace on turnover intention of clinical nurses: The mediating role of job satisfaction. BMC Nursing, 23(1), 844. https://doi.org/10.1186/s12912-024-02477-9

Musaed, A. (2023). The relationship between nurse burnout, job satisfaction, and patient care quality. Igm Publication. https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality

Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Frontiers in Psychology, 13, 896156. https://doi.org/10.3389/fpsyg.2022.896156

Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients' outcomes: A systematic review. Nursing Reports, 13(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

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

Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare

Yailin Ramirez

Florida National University

Decision Making-DAX-DL01

Dr. Nora Hernandez-Pupo

May 21, 2026

Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare

I. Introduction

A. Background Information. In the healthcare setting, workplace violence (WPV) is defined by physical assault, threats, verbal harassment and incivility towards patients, families and healthcare professionals. Bedside nurses in acute/ inpatient settings have the highest rate of violence, which is disproportionately high for healthcare workers. Kafle et al. (2022) confirmed WPV as a sustained epidemic in the nursing profession; Ramzi et al. (2022) reported elevated prevalence all over the world during the COVID-19 pandemic; and Amin et al. (2024) reported high prevalence among the nurses in tertiary care hospitals with severe psychological impact on them.

B. Statement of the Problem. Normalization, fear of retaliation, and poor organization protocols are all responsible for the underreporting of WPV. The cascading effect of moral distress, burnout and turnover leads to dangerous staffing levels and lower patient safety. Luo et al. (2024) found that psychological violence had a significant effect on decreased job satisfaction, which in turn predicted turnover intention, while Musaed (2023) found that psychological violence led to nurse burnout, which consequently affected the quality of patient care.

C. Thesis Statement: Shared decision-making model, transformational leadership, and interventions aimed at building nursing resilience can be seen as a multi-disciplinary strategy to address workplace aggression and create a safe environment that will contribute to nurse safety, retention, and better patient outcomes.

II. Literature Review/Background

A. Overview of Existing Research. WPV causes moral distress and staffing shortages, affecting not only bedside nurses, but nurse leaders and advanced practice nurses as well. Boudreau and Rhéaume (2024) showed that work environment factors play significant mediating roles on adverse nurse outcomes, and Lim et al. (2023) showed that the inpatient psychiatric nurses might have experienced persistent aggression and complex emotional consequences which needed immediate systemic and therapeutic response.

B. Key Theories and Models.

1. Shared Decision-Making (SDM) Model. According to Lomborg et al. (2025), Shared Decision Making (SDM) model is a decision-making process involving nurse, patient, and family to come up with care decisions, behaviors, and safety.

2. Transformational Leadership Model. According to Ystaas et al. (2023), this will lead to improvement of the nursing working environment and patient's outcome because of the use of idealized influence, empowerment, and intellectual stimulation leading to collective vision.

3. Nursing Resilience Interventions. According to Henshall et al. (2020), these are some of the interventions that a nurse could adopt to build resilience, adaptive decision making, emotion regulation, and protection when faced with violence or stressful healthcare environment.

III. Main Body/Discussion

A. Section One

Topic Analysis and Context.

WPV varies by the nursing continuum. During high acuity interventions and basic care activities, bedside nurses face the direct aggression and incivility of patients (Lim et al., 2023). Nurse managers deal with staffing consequences, policy application and post incident debriefing. APN's support institutional policies, risk assessment systems based on evidence, and legislative advocacy at the macro-level to prevent.

B. Section Two

Comparative Analysis.

· Bedside/Staff Nurse. Nursing resilience interventions support nurses in becoming more aware of de-escalation behaviour in earlier stages (Henshall et al., 2020) and to learn how to de-escalate and self-protect. SDM supports patients and their families to draw boundaries along with forming relationships to deliver non-violent care.

· Nurse Leader/Manager. Transformational leadership helps achieve good implementation of a zero tolerance policy at the unit level, provides empowerment to staff through shared governance safety committees and security and training resources (Ystaas et al, 2023)

· Advanced Practice Nurse. SDM can help with the formulation of a full and person-centred evaluation of violence risks and planning around trauma-informed care (Lomborg et al., 2025). Transformational leadership can facilitate building an interprofessional coalition, organizational policy changes and engaging community stakeholders for systemic changes (Ystaas et al., 2023).

C. Section Three

Application, Implications, and Funding.

For continuity of prevention ecosystem: Behavioural resilience interventions safeguard the immediate safety; SDM strengthen therapeutic trust and adherence; transformational leadership reshapes the organization’s culture around psychological safety. Challenges include resource constraints, state level reporting differences and organizational resistance. It includes the following recommendations: Report incidents electronically in a private and confidential fashion, and standardize it within the organization; conduct a teacher debrief; provide organization-wide education and training; and explicitly model teacher leadership by senior leaders publicly demonstrating their commitment.

Funding Source: Through HRSA, as one of the programs under NEPQR, funding will be made available to implement a unit-based WPV prevention program comprising staff resilience training, environmental safety measures, and an electronic reporting mechanism that facilitates confidential reporting of infections (HRSA, 2024).

IV. Conclusion

A) Key Point Summary. Responses to WPV must be coordinated and addressed on the level of the vertical line, or vertical level. The frameworks cover different nursing roles and come together to support a comprehensive prevention approach – from individual coping to relationship care to systems re-design.

B. Implications & Next Steps. Transformational leadership as the most important systems level intervention supported by SDM and resiliency interventions at the direct-care levels will be emphasized focally within the final paper in order to propose evidence-based and sustainable solutions to workforce safety, nurse retention, assessable increases in patient quality and the improvement of organizational culture.

V. Preliminary References

Amin, R., Shah, S., Nawaz, N., Altaf, M., & Shehzadi, A. (2024). Prevalence and impact of workplace violence among nurses in tertiary care hospitals. Biological and Clinical Sciences Research Journal, 2024(1), 956. https://doi.org/10.54112/bcsrj.v2024i1.956

Boudreau, C., & Rhéaume, A. (2024). Impact of the work environment on nurse outcomes: A mediation analysis. Western Journal of Nursing Research, 46(3), 210–218. https://doi.org/10.1177/01939459241230369

Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories. Journal of Clinical Nursing, 29(19–20), 3597–3599. https://doi.org/10.1111/jocn.15276

Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review. Journal of Clinical and Translational Research, 8(5), 421–424.

Lim, Z. Y., Idris, D. R., Abdullah, H. M. A. L., & Omar, H. R. (2023). Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study. Archives of Psychiatric Nursing, 46, 83–90. https://doi.org/10.1016/j.apnu.2023.08.008

Lomborg, K., Finderup, J., Thorne, S., & Søndergaard, H. (2025). Shared decision making in nursing and advanced practice nursing. In Oxford textbook of shared decision making in healthcare (pp. 288–291). https://doi.org/10.1093/med/9780198897804.003.0057

Luo, Y., Zhang, M., Yu, S., Guan, X., Zhong, T., Wu, Q., & Li, Y. (2024). The impact of psychological violence in the workplace on turnover intention of clinical nurses: The mediating role of job satisfaction. BMC Nursing, 23(1), 844. https://doi.org/10.1186/s12912-024-02477-9

Musaed, A. (2023). The relationship between nurse burnout, job satisfaction, and patient care quality. Igm Publication. https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality

Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Frontiers in Psychology, 13, 896156. https://doi.org/10.3389/fpsyg.2022.896156

Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients' outcomes: A systematic review. Nursing Reports, 13(3), 1271–1290. https://doi.org/10.3390/nursrep13030108