| Horizontal violence contributes to an unsafe work environment and adversely affects patient outcomes. It affects nurses' health, morale, and sense of worth, and is a factor in recruitment and retention. Despite increased awareness and Joint Commission mandates requiring healthcare institutions take action to eliminate disruptive behaviors, the problem remains unresolved.;The majority of nursing studies to date have focused on describing associated behaviors, measuring prevalence, and identifying antecedents and consequences. Most are based on survey data, relying on self-report. Because horizontal violence is poorly defined and studies indicate that nurses minimize its associated behaviors, self-report alone may not adequately reveal the complexities of the phenomenon. The purpose of this study was to explore individual nurses' perceptions of horizontal violence within the context of their work environment to inform the development of future interventions to improve recognition of the phenomenon.;This descriptive study utilized elements of ethnography and phenomenology. Policies and codes of conduct were analyzed. Observation (370 hours) was used to develop an understanding of the context and culture of two inpatient hospital units. In addition, 35 members of staff shared their perceptions of horizontal violence, broadly defined as "any physical or emotional, non-caring or non-supportive behavior between nurse colleagues," factors they believe contribute to the perpetuation of these behaviors, and their own experiences of the phenomenon. Data was coded and analyzed thematically.;Results indicate that horizontal violence is perpetuated by lack of recognition and causal attributions. Reporting is inhibited by fear of reprisal, isolation, and labeling. Systems problems are also identified as contributing to the phenomenon. The majority of behaviors identified would not meet criteria for workplace violence as defined under existing policies, but would be prohibited under codes of conduct, which were not enforced. Addressing horizontal violence was not a priority on either unit.;Finding support existing theories of horizontal violence. The phenomenon is revealed as multifactorial; indicating that interventions focused on a single cause may not be effective. Future interventions must address the complexity of phenomenon. The results of this study illustrate some of this complexity and may be used to inform the design of future interventions. |
