Background

Lateral violence (LV) is nurse-to-nurse aggression.

Behavior directed by one peer toward another that

disrespects, or devalues the worth of the recipient.

Vertical violence (VV) is a nurse in a position of

power exhibiting aggressive or abusive behaviors

over a person in a lower position of power.

Lateral and vertical violence in healthcare places

the patient at risk for harm secondary to errors in

communication.

Computer based training (CBT) is a convenient,

lower cost method of sharing information with a

large population of people and can be completed at

random times. CBT does not require special

scheduling or instructors.

Cognitive Rehearsal is a strategy that employs

the use of cognition and automatic thoughts. The

act of consciously not reacting to LV or VV, allows

time to process and respond based on what they

have previously been taught.

Gap in the Literature - No studies have compared

the use of CBT and in person training such as

cognitive rehearsal.

The Effects of Two Educational Interventions on Lateral and Vertical Violence in the

Nursing WorkplaceEileen Phillips DNP, RN, NE-BC

Thomas Jefferson University and Main Line Health SystemMethods, Setting and Sample

Mixed method design

Pre- and post-intervention survey using the Stanley,

et al, 2011 Lateral and Vertical Violence in Nursing

Survey

(LVNS+V).• 25 questions using a 4-point Likert scale • 3 open-ended questions + demographic

information

Setting and Sample• Suburban hospital in a 5 hospital health system • 69 female participants • Obstetric department nurses• 1 Asian, remainder White• Years experience

Pre survey n-41 Post survey n-293 < 2 yrs 2 <2 yrs6 3-10 yrs 4 3-10 yrs32 >10 yrs 23 > 10 yrs

InterventionsRandom assignment to one intervention groupComputer Based Training Group n=25 76% participation

• Free CBT through Lippincott

• Encouraged participation but voluntary

• 50 minutes in length, paid for their time

Cognitive Rehearsal Classn= 1958% participation

• Register for a class in Healthstream

• Class size ranged from 1-7 participants

• 1 hour in length, paid for their time

• 22 minute video, tip sheet and role-playing conversation

Results

The survey question regarding types of

education/training received about LV or VV did not

distinguish which intervention group the participant

was assigned to. Therefore, the inability to identify

which intervention group the participants were

assigned to, forced the combination of the

intervention groups for analysis.

The revised objective became to see if any

educational interventions (CBT or cognitive rehearsal)

were effective in addressing lateral or vertical

violence.

The following two questions were statistically

significant:

I am the recipient of vertical violence directed downward

Mean pre 1.00, Mean post 1.26 (p=0.047)

I feel adequately prepared to respond to episodes of lateral or vertical violence

Mean pre 2.69, Mean post 3.00 (p=0.025)

Open ended questions- Identified the desire for

continued education on the subject, the desire for

nurse leader intervention to address continued

behaviors, sensitivity training for more senior nurses

and assertiveness training for others.

Clinical Questions

1. Did the computer-based or cognitive rehearsal

training improve the nurses’ understanding and

recognition of Lateral and vertical violence?

2. Did the computer-based or cognitive rehearsal

training improve the nurses’ perceived ability to

respond to episodes of LV/VV?

Conclusions

This study has demonstrated:

1- Nursing staff feel adequately prepared to respond

to episodes of LV and VV after receiving education

on the subject.

2-Staff felt they were recipients of vertical violence

directed downward.

3-The open-ended questions supported the

perception of the less experienced nurses

experiencing VV directed downward from the more

senior nurses.

The evidence indicates LV and VV behaviors

contribute to poor patient outcomes due to impaired

communication among nursing professionals. Nurse

administrators have a responsibility to minimize or

eradicate such behaviors in the workplace.

Providing education to all nurses about LV and VV

will support the AACN Skilled Communication

standard that states, “Nurses must be as proficient

in communication skills as they are in clinical skill”

(AACN, 2005, p.13).

Implications for Nursing Leadership