Moffa, Christine M.

Workplace mistreatment (bullying, horizontal violence, and incivility) has been
shown to impact nurses’ work satisfaction, job turnover, and physical and mental health.
However, there are limited studies that examine its effect on patient outcomes. A
correlational descriptive study of 79 acute care nurses was used to test a social justice
model for examining the relationship between workplace mistreatment, quantified as
threats to dimensions of nurses’ well-being (health, personal security, reasoning, respect,
attachment, and self-determination), and nurses’ ability to provide quality patient care. In
addition, this study considered the moderating effect of caring work environment among
co-workers on nurses’ ability to provide quality patient care in the face of workplace
mistreatment. Stories of workplace mistreatment were collected anonymously and
analyzed for alignment with threats to six dimensions of well-being. Ability to provide
patient care was measured using the Healthcare Productivity Survey and a caring work
environment was measured via the Culture of Companionate Love scale. The results demonstrated that threats to all six dimensions of well-being described
by Powers and Faden (2006) were expressed in nurses’ stories of workplace
mistreatment. Furthermore, 87% reported a decrease in ability to provide patient care
after an incident of workplace mistreatment. Yet frequency of threatened dimensions did
not have a significant relationship with ability to provide patient care. Moreover, there
was a significant moderator effect of the caring work environment on the relationship
between number of threatened dimensions of well-being and ability to provide quality
patient care. Nurses in high caring environments loss less ability to provide care than
nurses in low caring environments when one to three dimensions of well-being were
threatened. However, this relationship reversed when four or more dimensions were
threatened. Implications include further research on the relationship between workplace
mistreatment and nurse well-being and changing practice to include fostering a caring
work environment in healthcare facilities.

The use of the telephone to speak to study participants about health-related issues is
useful when logistics make it difficult for participant and researcher to meet in person. However,
gaining the trust of the participant can be a challenge, partly due to fears of fraud and identity
theft. A spirit of openness and caring must come across the telephone lines between interviewer
and interviewee. Roach’s six C’s can be applied to convey a sense of caring, thereby relaxing the
participant and increasing their sense of safety to enhance the quantity and quality of health data
being collected. According to Roach, caring is manifested through six C’s – compassion,
competence, confidence, conscience, commitment, and comportment. Interviewers can be trained
through role playing and scripting using Roach’s caring model. Compassion is expressed by
being sensitive to the anxiety and apprehension they may feel toward receiving a call from a
stranger, who is asking about health-related issues. Competence is expressed by being able to
give the participant the information they need to have an understanding as to what they are
consenting. Confidence is achieved by ensuring the participant that the information they share
will be used appropriately and for the greater-good. Conscience is expressed by following ethical
research protocols, adhering to confidentiality, and respecting the relationship with the research
participant. Finally, interviewers manifest caring through comportment by identifying
themselves with their name, credentials, and institution; addressing the participant formally;
using language the participant can understand; and projecting caring through tone of voice.