Preventing Lateral Violence at Houston Methodist

In this

issue

WELCOME

NURSING SCIENCE

Prevalence of lateral violence in nurse workplace: A systematic review and meta-analysis

Workplace Violence and Incivility in Graduate Nurses – How Are We Addressing It and What Should You Do?

EDUCATION

Incivility and Bullying in the Workplace

PRACTICE

Workplace Violence in the Emergency Department

PROFESSIONAL DEVELOPMENT

Workplace Environment Council

What Should I Do When Facing Lateral Violence?

FROM OUR TEAMS

Preventing Lateral Violence at Houston Methodist

Workplace Violence: Which Role Have You Played?

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

7.26

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

7.32

(7.35-7.45)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

7.49

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

7.51

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

Preventing Lateral Violence at Houston Methodist

By LaToya C. Clower, MSN, RN, CVRN-BC

Lateral violence has presented a growing, national trend in the healthcare setting. Each year, nearly 1.5 million incidences of workplace attacks are reported. Unfortunately, many workplace incidents also go unreported. Lateral violence can be defined as any act or threat of physical violence, harassment, intimidation, bullying or disruptive behavior that occurs from peer to peer within an organization.

As patient care assistants, lateral violence may be experienced through nurses, physicians, or even managers. Long-term effects of lateral violence can include negative effects on self-confidence, the onset of emotional distress, stress-related health problems, and even lower staff retention rates.  Each of these can be debilitating, ultimately affecting overall work performance and the ability to deliver optimal patient care.

The safety and security of employees are of vital importance to Houston Methodist. Our goal as an organization is to shift these statistics by enforcing policies and procedures that focus on prompt identification, rapid intervention, conflict resolution, and ultimately, workplace violence prevention. The Workplace Violence Prevention Program was created by various departments and committees that enforce and manage system-wide measures to maintain a violence-free workplace environment. The program enforces routine evaluation of the conduct and behavior of staff, physicians, contractors, visitors and patients. It also provides clinical intervention for aggressive or violent patients and ongoing training policies relating to violence prevention and reporting procedures.

Although this only provides a glimpse into the current policies and procedures in place, the primary goal for Houston Methodist remains clear: There is zero tolerance for workplace violence here. As an organization, our goal is to have a workplace free from threats or acts of violence and to respond effectively if such acts or threats of violence occur. This goal of a violence-free workplace can only be realized when patient care assistants like you report what you experience or witness. So, if you see something, say something! Reports can be made immediately to a supervisor, human resources, security, or the D3 Security E-alert found on the intranet page.

FROM OUR TEAMS

Workplace Violence: Which Role Have You Played?

PROFESSIONAL DEVELOPMENT

What Should I Do When Facing Lateral Violence?

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