International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 Volume 4 Issue 4, April 2015 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Perception of Nurses toward Horizontal Violence in Health Care Settings in Taif City, Saudi Arabia Ibrahim R. Ayasreh 1 , Hanan A. Youssef 2 , Fedaa A. Ayasreh 3 1 RN, MSN, Lecturer of Critical Care Nursing, College of Applied Medical Sciences, Taif University 2 Head of Nursing Department, Assistant Professor of Critical Care Nursing, College of Applied Medical Sciences, Taif University 3 RN, BSN, Jerash University, Jordan Abstract: Horizontal violence is one of devastating issues as being an obstacle in developing nursing profession. Objective : To identify nurses’ perceptions toward horizontal violence in health care settings in Taif City in Saudi Arabia. Method : Quantitative descriptive correlational design was conducted on 100 nurses in selected settings in Taif city, Saudi Arabia. Results : 94% of nurse participants in this study witnessed at least one type of horizontal behaviors during their work. Findings revealed that covert behaviors were more common than overt ones. Covert acts of horizontal violence as perceived by nurse participants focuses mainly on lack of respect and communication between nurses. Fear of retaliation, fear of being ridiculed if asking questions, discouragement and job dissatisfaction were the most common effects of horizontal violence. Participants perceived that Peers including registered nurses and practitioner nurses were the most common perpetrators of horizontal violence. Conclusion : Although horizontal violence was extensively covered in nursing literature, this study demonstrated incessant existence of this problem. Horizontal violence has mischievous effects that extend from the nurse victims to the whole health care team and eventually to the patients. Developing educational programs on appropriate professional behaviors and code of nursing ethics and training courses on conflict managements for nursing staff and managers, is so effective in elimination with horizontal violence cases. Keywords: Horizontal Violence, Nursing Profession, Covert Behaviors, Overt behaviors, Perception 1. Introduction Horizontal violence is one of the most serious phenomena which invade nursing profession. It has shown to bring about a significant effects on nursing work and practice specifically on workplace satisfaction and retention as well as the quality of care provided by nurses toward their clients. 1 There is still no agreed-on definitions of horizontal violence in nursing literature, as that some nurse researchers focused on physical dimensions in defining horizontal violence whereas others focused on emotional and psychological dimensions .additionally, horizontal violence is used interchangeably in literature with many other terms such as lateral violence, mobbing, bullying, nurse hazing, and workplace aggression. According to Woelfle and McCaffery (2007), horizontal violence is defined as any act or behavior of hostility or aggression, which could be oral, emotional, or physical, carried out by a coworker towards another coworker. 2 There are many forms of horizontal violence experiencing by nurses in different areas ranging from covert non-verbal insinuations to overt physical violation 3, 4, 5 . In her 2004 article, Dr. Griffin listed the most frequent lateral violence behaviors faced by nurses in different settings , beginning with nonverbal innuendo as the most frequent behavior followed by verbal affront, undermining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and finally broken confidences 6 . The exact prevalence of horizontal violence in nursing field Is relatively unknown 7, 8, and this may be related to lack of unified agreed-on definitions of horizontal violence among nurses within different cultures 9 . Additionally, most of the horizontal violence cases are usually not reported or conveyed to responsible authorities 10. So that it was difficult to determine accurate statistics about horizontal violence occurrence. Nevertheless, previous investigations affirmed that horizontal violence is widely prevalent among nurses in health institutes and some studies estimated that 65% - 80% of nurses were subjects to different types of violence in health institutes. 10, 11 Horizontal violence is serious problem which has may devastating effects on nursing as a profession and on nurses themselves as humans. According to McIntosh (2005), horizontal violence has many negative effects on physical and mental health of nurses. Physical signs and symptoms include headaches, tearfulness, dry throat, gastrointestinal problems, changes in body weight, sleep disturbances, diminishing energy, exhaustion, disrupted concentration, and hypervigilance. Whereas mental signs and symptoms include feeling fearful, an increasing lack of joy and hope, declining confidence, and feeling resigned, angry, depressed, and disappointed 12 , and these impacts lead to decreased productivity and decreased self-esteem, and will affect the quality of care provided by these nurse toward their clients. Additionally, horizontal violence negatively affect patient safety, as horizontal violence conflicts with establishing effective therapeutic relationship between nurses and clients. 7, 13 This study is aimed to: Identify nurses’ perceptions toward horizontal violence in health care settings in Taif City in Saudi Arabia Paper ID: SUB153236 1017